Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis

Abstract

Smedler E, Sparding T, Hattab A, Sellgren CM, Land en M. Reporting trigger factors for (hypo)manic episodes in bipolar disorder: association with personality and prognosis.Objective: To investigate external factors that trigger manic and hypomanic relapses and how this is associated with personality and clinical outcome measured as number of affective episodes over a 7-year period. Method: This is a prospective cohort study of 204 meticulously characterized Swedish bipolar disorder patients. Personality was evaluated at baseline using the Swedish universities Scales of Personality in 170 patients, and 90 patients were followed up after approximately 7 years in order to evaluate clinical outcomes. Results: We found that 44% of the patients reported trigger factors, including sleep disturbance, work-or family-related issues, medication, and illicit drug use. There were no significant differences in any of the personality traits when comparing the 74 patients that reported triggers with the 90 patients that did not. At 7-year follow-up, there was no difference between the groups in number of affective episodes (depressive, hypomanic, manic, or mixed), involuntary commitments, suicide attempts, or self-harm incidents since baseline. Conclusions: Around 40% of the patients reported external triggers for manic and hypomanic episodes. However, this was neither associated with personality traits nor number of affective episodes at 7-year followup.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Significant outcomes• Around 40% of all bipolar disorder patients reported trigger factors for manic or hypomanic episodes.• Reporting trigger factors was not associated with personality • Reporting trigger factors was not associated with outcomes over a 7-year period. Limitations• Patients had on average long duration of illness and may be less sensitive to external stressors than persons with recent onset.• Trigger factors were identified retrospectively and may thus be prone to recall bias. • The number of affective episodes might be a too crude outcome measure as most subjects had not suffered any affective episodes at follow-up.

Cohort Profile: The St. Göran Bipolar Project

“…With respect to personality traits, we found that individuals with bipolar disorder scored higher on measures of Neuroticism, Aggressiveness, and Disinhibition compared with controls, but these personality traits were neither associated with worse outcome in bipolar disorder [44], nor with the presence of trigger factors for affective episodes [45].…”

Diagnostic considerations in identifying bipolar disorder in primary care

“…In the meantime, treatment with the usual fi rst-line antidepressant medications may result in the patient "switching" to a manic or hypomanic state. 1 Additionally, because of permanent brain changes that occur in untreated bipolar illness, the longer a person goes without proper treatment, the more irreversible functional defi cits can occur. Th erefore, it is important that the primary care NP screen for BD in patients presenting with symptoms of depression as well as collaborate with and make appropriate referrals to psychiatry so that these patients receive appropriate treatment.…”

“…Because patients typically seek treatment for depressive symptoms rather than for elevated and expansive mood, it often takes many years for BD to be properly diagnosed, which puts patients at higher risk for attempted or completed suicide. In the meantime, treatment with the usual first-line antidepressant medications may result in the patient “switching” to a manic or hypomanic state 1. Additionally, because of permanent brain changes that occur in untreated bipolar illness, the longer a person goes without proper treatment, the more irreversible functional deficits can occur.…”

The efficacy of vitamin B6 as an adjunctive therapy to lithium in improving the symptoms of acute mania in patients with bipolar disorder, type 1; a double‐blind, randomized, placebo‐controlled, clinical trial

“…In this severe mood disorder, manic or depressed episode leads to disability of the individual and social functioning of the patient (Rosa et al., 2010 ). Aggression, disinhibited behaviors and disturbed sleep, are some of the symptoms of manic episodes of this disorder (Smedler et al., 2020 ). Despite some differences in the results of some studies, the lifetime prevalence of this disorder estimates 3.3% and its 12‐month prevalence as equal to 2% (Sadocket al., 2017 ).In some studies, the prevalence rate of unipolar mania among patients with bipolar disorder has been reported to be 5% to 7.2% (Baek et al., 2014 ).…”