Bipolar Disorder: Mitchell P

Ghaemi SN, Bauer M, Cassidy F, Malhi GS, Mitchell P, Phelps J, Vieta E, Youngstrom E, Anonymous00020. · Bipolar Disorder Research Program, Department of Psychiatry, Emory University, Atlanta, GA 30322, USA. · Bipolar Disord. · Pubmed #18199230 No free full text.

Abstract: The Diagnostic Guidelines Task Force of the International Society for Bipolar Disorders (ISBD) presents in this document and this special issue a summary of the current nosological status of bipolar illness, a discussion of possible revisions to current DSM-IV and ICD-10 definitions, an examination of the relevant literature, explication of areas of consensus and dissensus, and proposed definitions that might guide clinicians in the most valid approach to diagnosis of these conditions given the current state of our knowledge.

Barnes C, Mitchell P. · School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia. · Aust N Z J Psychiatry. · Pubmed #16050920 No free full text.

Abstract: OBJECTIVE: Recent research has emphasized important gender differences in the epidemiology, course, comorbidity and treatment of bipolar disorder. This article aims to provide an overview of these important findings in order to assist the clinician in treating women with bipolar disorder. Complex issues regarding the treatment of bipolar disorder during pregnancy and the post-partum period are discussed. METHOD: A literature review was undertaken using Medline (1966-current), PsychInfo and PubMed databases. Search terms used were gender, sex, women, bipolar disorder, suicide, epidemiology, rapid cycling, mixed episode, treatment, mood stabilizers, antidepressants, antipsychotics, pregnancy, post-partum, menopause, lactation and breast-feeding. RESULTS: The lifetime prevalence of bipolar I disorder is equal in men and women; however, bipolar II appears to be more common in women. Gender differences have been reported in the phenomenology, course and outcome of this condition. Some comorbid disorders, such as thyroid disease and anxiety disorders have more relevance to women. Increasingly, sex differences in the pharmacokinetics and pharmacodynamics of medications used in bipolar disorder are being reported. CONCLUSIONS: There is increasing evidence for gender differences in a number of clinical features of bipolar disorder that have relevance to management. Although more studies are needed, it is important for clinicians to be aware of these issues to optimize treatment of women with this condition.

Ball J, Mitchell P, Malhi G, Skillecorn A, Smith M. · Bipolar Disorders Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia. · Aust N Z J Psychiatry. · Pubmed #12534655 No free full text.

Abstract: OBJECTIVE: Acceptance of, and adaptability to illness, are major determinants of adherence to treatment and functional recovery. This paper addresses the major psychosocial factors associated with bipolar disorder and the role of psychological interventions in symptom management and adaptability to the illness experience. A new model is presented highlighting the role of developmental experiences and temperament in determining reactions to bipolar disorder. The authors propose that by addressing reactions to the illness experiences and effects on self-concept through schema-focused cognitive therapy, functional recovery is more likely to occur among those patients functioning below expectation. METHOD: A systematic review of the current literature including an Index Medicus/MEDLINE search was conducted, focusing on risk factors, cognitive vulnerabilities and triggers associated with bipolar disorder. Psychological treatments available for the treatment of bipolar disorder are reviewed and details of a novel schema-focused cognitive model for this condition are presented. Traditional models of adaptation to chronic illness are outlined and incorporated into the proposed model. Schema-focused cognitive therapy is proposed as an approach to help patients reduce cognitive vulnerability to relapse in addition to adopting effective mood management strategies. RESULTS AND CONCLUSIONS: There is a need for psychological treatments which reduce the risks associated with poor functionality in patients with bipolar disorder. Schema-focused cognitive therapy specifically targets the temperament, developmental experiences and cognitive vulnerabilities that determine adjustment to illness. This proposed treatment, combined with pharmacotherapy, may offer new psychotherapeutic options for the future.

Bowden CL, Mitchell P, Suppes T. · Department of Psychiatry, University of Texas, Health Science Center at San Antonio, 78284-7792, USA. · Eur Neuropsychopharmacol. · Pubmed #10524837 No free full text.

Abstract: Several case reports and open studies have reported the efficacy of lamotrigine in bipolar depression. A randomised placebo-controlled 7-week study comparing two doses of lamotrigine with placebo in 195 patients with moderate to severe bipolar depression has now been completed. Lamotrigine was superior to placebo after 3 weeks as assessed by changes in the Montgomery-Asberg Depression Rating Scale (MADRS). A response, defined as more than 50% improvement on the MADRS occurred in 56 and 48% of the lamotrigine 200 and 50 mg/day groups, respectively, compared with 29% for placebo (P<0.05). There was no evidence that lamotrigine destabilised mood or precipitated mania. Tolerability was good and there were no cases of serious rashes. Preliminary results from an ongoing study also indicate that lamotrigine is more effective than gabapentin in bipolar depression. In conclusion, lamotrigine is effective in alleviating bipolar depression, without causing mood destabilisation. Slow dosage escalation yields good tolerability.

Parker G, Parker K, Mitchell P, Wilhelm K. · School of Psychiatry, University of New South Wales, and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, Randwick, Sydney, Australia. · Curr Opin Psychiatry. · Pubmed #16639176 No free full text.

Abstract: PURPOSE OF REVIEW: A 2004 review of 'atypical depression' in Current Opinion in Psychiatry could be read as more reifying the Columbian and DSM-IV concept rather than considering an alternative model that has been supported by independent studies undertaken in Australia and North America. Additional analyses of the Australian data set are reported to examine inter-study agreement further and to consider the implications. RECENT FINDINGS: Both studies recruited patients meeting criteria for a major depressive episode, and then contrasted patients meeting or not meeting DSM-IV criteria for definite atypical depression. In both studies, those with atypical depression were comparable in terms of female preponderance, age, age at first episode and depression severity, but developed earlier and more persistent episodes, showed a slight female preponderance, and were more likely to meet criteria for panic disorder, social phobia and hypochondriasis, and of avoidant and dependent personality styles. In both, there was a lack of evidence suggesting that atypical depression differs in severity, in being clearly less likely to have certain 'endogeneity' symptoms, or in being more likely to be associated with bipolar disorder, while neither the centrality of mood reactivity nor interdependence of symptoms could be demonstrated. SUMMARY: Findings from both studies challenge the view that atypical depression is an entity and the current model of its constituent features. Both found support for primacy of personality style (rather than mood reactivity) and for certain expressions of anxiety. Both effectively argue for and assist shaping of a revisionist model for conceptualizing atypical depression as a syndrome or spectrum disorder.

Parker G, Malhi G, Mitchell P, Kotze B, Wilhelm K, Parker K. · School of Psychiatry, University of New South Wales, Sydney, Australia. · Aust N Z J Psychiatry. · Pubmed #16168017 No free full text.

Abstract: OBJECTIVE: As deliberate self-harm (DSH) is a common concomitant of depressive disorders, we undertook a study examining the relevance of possible determinants and correlates of DSH. METHOD: Three separate samples of depressed outpatients were studied to determine consistency of identified factors across samples, with principal analyses involving gender, age and diagnosis-matched DSH and non-DSH subjects. RESULTS: Across the samples, some 20% of subjects admitted to episodes of DSH. Women reported higher rates and there was a consistent trend for higher rates in bipolar patients. Univariate analyses examined the relevance of several sociodemographic variables, illicit drug and alcohol use, past deprivational and abusive experiences, past suicidal attempts and disordered personality functioning. Multivariate analyses consistently identified previous suicide attempts and high 'acting out' behaviours across the three samples, suggesting the relevance of an externalizing response to stress and poor impulse control. CONCLUSIONS: Results assist the identification and management of depressed patients who are at greater risk of DSH behaviours.

Parker G, Parker K, Malhi G, Wilhelm K, Mitchell P. · School of Psychiatry, University of New South Wales, and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia. · Acta Psychiatr Scand. · Pubmed #15049773 No free full text.

Abstract: OBJECTIVE: To examine the extent to which identification of any distinct personality characteristics in bipolar subjects are influenced by selection of the comparison diagnostic group. METHOD: Scores were compared on several general measures of personality style and, additionally, the prevalence of disordered personality functioning was examined in a sample of 198 non-psychotic depressed subjects, 39 with bipolar depression and 159 with unipolar depression. RESULTS: When the bipolar subjects were separately compared with unipolar subjects, and to sub-sets of those with clinically and DSM-IV defined melancholic and non-melancholic depression, quite differing results were suggested. In essence, clinically-defined melancholic subjects had the least personality psychopathology in comparison with the non-melancholic and bipolar subjects. CONCLUSION: Whether subjects with bipolar disorder have any distinct personality characteristics or over-represented co-morbid personality disorders remains quite unclear when reference is made to the literature. We suggest that inconsistencies across studies may reflect choice and representation of depressive sub-types within the unipolar comparator group.

Daniels BA, Kirkby KC, Mitchell P, Hay D, Bowling A. · Discipline of Psychiatry, University of Tasmania, GPO Box 252-27, Hobart, Tas. 7001, Australia. · J Affect Disord. · Pubmed #12798256 No free full text.

Abstract: BACKGROUND: Patients on a first admission for bipolar disorder often have a history of other psychiatric diagnoses for previous admissions. AIMS: The current study examines the time course and diagnoses of psychiatric admissions prior and subsequent to a first hospitalisation for a diagnosis of bipolar disorder. METHOD: The prior admission histories (over the period 1965-1989) of 1167 patients who had been hospitalised in state mental health facilities with their first admission with diagnosis of bipolar disorder between 1983 and 1989 were examined. RESULTS: A total of 542 (46.4%) patients had at least one previous hospitalisation with a psychiatric diagnosis other than bipolar disorder. Two prominent groups emerged; one group which had primarily a history of prior admissions with diagnoses of depression over 1-3 years, and a second which mainly had previous admissions for schizophrenia, over a period longer than for those with a primarily depressive history. The group with a history of schizophrenia was significantly younger and had a greater number of admissions prior to the first bipolar disorder diagnosis than the depression group. LIMITATIONS: This was a record-based study which did not examine cases which were not hospitalised. CONCLUSIONS: There appeared to be three distinct patterns of prior presentations in those patients admitted with a diagnosis of bipolar disorder.

Brodaty H, Mitchell P, Luscombe G, Kwok JJ, Badenhop RF, McKenzie R, Schofield PR. · School of Psychiatry, University of New South Wales, Sydney, Australia, · Hum Genet. · Pubmed #11810290 No free full text.

Abstract: Idiopathic basal ganglia calcification (IBGC) is characterised by radiological, neurological, cognitive and psychiatric abnormalities. The associations between these abnormal phenotypes and abnormal genes remain unclear despite the recent mapping to chromosome 14q of a susceptibility locus for IBGC ( IBGC1). We identified two siblings, from a large multigenerational pedigree, who had both been diagnosed with radiological IBGC, dementia, bipolar affective disorder and Parkinsonism. We assessed (1) other family members to determine whether these four phenotypes were co-segregating as symptoms of IBGC, and (2) possible IBGC linkage to the IBGC1 locus on chromosome 14q or to any known or potential dementia genes. Nine second-generation and 21 third-generation members received radiological, neurological, neuropsychological and psychiatric assessments. We genotyped all family members for microsatellite markers at the IBGC1 locus and polymorphisms of the ApoE, VLDL, alpha1-ACT, BChE-K, APP, PS1, PS2 and tau genes and tested these for linkage to IBGC, dementia and bipolar disorder. Of the ten family members with radiological intracranial calcification, all except the two index cases were normal. There was no significant association between IBGC status and severe cognitive impairment or dementia ( P=0.335) or bipolar affective disorder or Parkinsonism ( P=1.0). Linkage to the IBGC1 locus was excluded. Of the eight dementia gene markers tested, the only positive LOD score was for the ApoE epsilon4 polymorphism and dementia/severe cognitive impairment. We have identified a form of IBGC in which calcification is inherited independently of neurological, cognitive and psychiatric symptoms. This may represent a second locus for this disorder.

Daniels BA, Kirkby KC, Mitchell P, Hay D, Mowry B. · Discipline of Psychiatry, Faculty of Health Sciences, University of Tasmania, Hobart, Australia. · Acta Psychiatr Scand. · Pubmed #10892608 No free full text.

Abstract: OBJECTIVE: Seasonal variation has been reported for both affective disorders and schizophrenia. The current study examines seasonal variation in admissions in schizophrenia, depression and bipolar disorder in Tasmania, the southernmost state of Australia. METHOD: All admissions with a diagnosis of schizophrenia, bipolar disorder and depression in Tasmania between 1983 and 1989 were examined for evidence of seasonal variation in admission patterns. RESULTS: Using the modified Kolmogorov-Smirnov statistic defined by Freedman no significant seasonal variation was found in admissions with diagnoses of mania, depression or schizophrenia. There was a significant seasonal variation in admissions with schizoaffective disorder (winter peak). CONCLUSION: There is no significant seasonal variation in admissions with schizophrenia, depression or bipolar disorder in Tasmania. This may be due to a combination of geographical location and the stringent test of seasonal variation used in the current study.

Parker G, Roy K, Wilhelm K, Mitchell P, Hadzi-Pavlovic D. · Mood Disorders Unit, Prince of Wales Hospital, Randwick, and School of Psychiatry, University of New South Wales, 2031, Randwick, Australia. · J Affect Disord. · Pubmed #10854638 No free full text.

Abstract: AIM: To examine if melancholic depression is over-represented in those with 'bipolar depression' and, if confirmed, to use that phenomenon to assist the clinical definition of melancholia. METHODS: We contrast 83 bipolar and 904 unipolar depressed patients on three melancholic sub-typing systems (DSM, Clinical and CORE system) and compare representation of their clinical depressive features. RESULTS: By all three melancholic sub-typing systems, the bipolar patients were more likely to receive diagnoses of 'melancholia' and of psychotic depression. To the extent that this differential prevalence of depressive sub-types was reflected in varying patterns of clinical features, we so indirectly identified a set of items defining 'melancholia'. By such a strategy, melancholia was most clearly distinguished by behaviourally-rated psychomotor disturbance. While a number of 'endogeneity symptoms' were significantly over-represented, logistic regression analyses refined the set to psychomotor disturbance (both as a symptom and as a sign) and pathological guilt. We also established a distinctly higher prevalence of bipolar depression in those where a refined diagnosis of melancholia was made. CONCLUSIONS: Bipolar depression appears to be more likely to be 'melancholic' in type, thus providing an indirect strategy for the clinical definition of melancholia.