Twelve-Month Outcome After a First Hospitalization for Affective Psychosis

Strakowski, Stephen M.; Keck, Paul E.; McElroy, Susan L.; West, Scott A.; Sax, Kenji W.; Hawkins, John; Kmetz, Geri F.; Upadhyaya, Vidya H.; Tugrul, Karen C.; Bourne, Michelle L.

doi:10.1001/archpsyc.55.1.49

Cited by 276 publications

(252 citation statements)

References 38 publications

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“…Patients were excluded if their manic symptoms were secondary to substance intoxication or withdrawal, if they had any lifetime substance dependence, or a lifetime substance abuse history of greater than ten years duration. Diagnoses were made using the Structured Clinical Interview for DSM-III-R-Patient edition (SCID-P; Spitzer et al 1990) performed by psychiatrists with established interrater diagnostic reliability ( kappa ϭ .94; Strakowski et al 1998). Retrospective chart reviews were used to assess lifetime duration of lithium exposure, as there are reports of lithium contributing to cerebellar degeneration (Donaldson and Cuningham 1983;Kores and Lader 1997).…”

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confidence: 99%

“…The areas of V1, V2, and V3 were measured on the realigned midsagittal slice by tracing the ROI and then using a thresholding technique. Total cerebral volumes were measured to control for differences in brain size when making comparisons (Strakowski et al 1993(Strakowski et al , 1998. Interrater reliability was established for each structure by having two raters independently measure each ROI from 10 subjects.…”

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confidence: 99%

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MRI Analysis of the Cerebellum in Bipolar Disorder A Pilot Study

DelBello

Strakowski

Zimmerman

et al. 1999

Neuropsychopharmacology

211

132

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Since qualitative CT studies have suggested decreased cerebellar size in patients with bipolar disorder, we performed a quantitative analysis of the cerebellum in patients with bipolar disorder to determine whether highresolution, thin slice magnetic resonance imaging (MRI) morphometry would reveal similar results. Bipolar patients hospitalized for a first manic episode ( n ϭ 16), bipolar patients with prior manic episodes hospitalized for a manic episode ( n ϭ 14), and normal volunteers ( n ϭ15Although traditionally regarded as a regulator of motor function, the cerebellum has also been found to project to regions of the brain that modulate mood (Anand et al. 1959;Heath et al. 1978;Courchesne et al. 1989). Several case reports have identified cerebellar atrophy in patients with mood dysregulation and in patients with bipolar disorder (Cutting 1976;Hamilton et al. 1983;Joseph et al. 1985;Yadalam et al. 1985;Jurjus et al. 1994).Moreover, several studies have found abnormal cerebellar anatomy in patients with affective disorders (reviewed in Soares and Mann 1997). Two studies reported a greater rate of cerebellar atrophy in manic patients than in patients with schizophrenia or normal controls (Nasrallah et al. 1981(Nasrallah et al. , 1982. Additionally, Yates et al. (1987) found a greater rate of cerebellar atrophy in patients with bipolar disorder who were over fifty years old, but not in younger bipolar patients compared with healthy volunteers. Lippmann et al. (1982) found bipolar patients with co-occurring alcohol abuse had increased rates of both vermal atrophy and cerebellar hemisphere atrophy compared with normal healthy volunteers, suggesting that alcohol abuse may contribute to abnormal cerebellar anatomy in bipolar patients. Rieder et al. (1983) found no difference in cerebellar size among patients with bipolar disorder, schizophrenia, and schizoaffective disorder. Results of these contradic- Despite numerous studies suggesting an association between cerebellar atrophy and bipolar disorder, there are no quantitative analyses of the cerebellum in patients with mania using MRI morphometry (Soares and Mann 1997). The aim of this study was to morphometrically assess the cerebellum of patients with bipolar disorder using high-resolution, thin slice, MRI, which allows for superior visualization of cerebellar anatomy.Previous investigators have found that lithium toxicity (Donaldson and Cuningham 1983;Kores and Lader 1997), depression (Shah et al. 1992;Escalona et al. 1993), and alcohol use (Lippmann et al. 1982) are associated with smaller cerebellar size. Therefore, cerebellar size may be associated with chronic affective illness or confounding variables associated with chronicity, such as number of previous episodes of depression, substance use, and medication effects. Yates et al. (1987) found that multiple-episode bipolar patients had a greater rate of cerebellar atrophy that healthy volunteers. Studying bipolar patients at the onset of their illnesses may eliminate confounding variables associated with ch...

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confidence: 99%

mentioning

confidence: 99%

MRI Analysis of the Cerebellum in Bipolar Disorder A Pilot Study

DelBello

Strakowski

Zimmerman

et al. 1999

Neuropsychopharmacology

211

132

View full text Add to dashboard Cite

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“…7 Patients without family history of affective disorders, without substance use, and older age were more likely to achieve functional recovery after 12 months. 7 In a study by Strakowski et al 32 including 109 patients in first-episode affective psychosis, similarly low functional recovery rates (35%) were observed. Symptom recovery was equally low (35%) ( Table 2), and lower than in prior studies.…”

Section: First Episode Of Mania (Stage Ii)mentioning

confidence: 91%

“…This diminished symptom recovery possibly occurred because the sample enrolled patients with major depression and BD who also had psychosis. 32 A recent study from the Systematic Treatment Optimization Program for Early Mania Project (STOP-EM) recruited a cohort of patients with BD type I without psychosis (n=53). 31 Almost 90% achieved syndromic recovery and 53% had symptom recurrence during 1-year follow-up (Table 2).…”

Section: First Episode Of Mania (Stage Ii)mentioning

confidence: 99%

Early stages of bipolar disorder: characterization and strategies for early intervention

Rios

Noto

Rizzo

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/ subsyndromal stage and first-episode phase, and strategies for their respective treatment. Methods: A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania. Results: As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase. Conclusions: Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.

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“…Responses to stressful events 23,24 Negative events are associated with depressive episodes; goal attainment events are associated with manic episodes; psychosocial treatments can modulate responses to stress High expressed emotion and negative family interactions 23,25,26 Crucial attitudes in caregivers and negative verbal interactions between caregivers and patients associated with greater likelihood of recurrence; family-focused therapy enhances family communication and is associated with reduction in mood symptoms Drug adherence [27][28][29] Psychoeducational treatments improve adherence to mood stabilisers, leading to lower likelihood of manic recurrence…”

Section: Psychosocial Variablesmentioning

confidence: 99%

The Treatment of Bipolar Disorder

Möller¹,

Nasrallah²

2017

Oxford Medicine Online

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We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes. Lithium has the strongest evidence for long-term relapse prevention; the evidence for anticonvulsants such as divalproex and lamotrigine is less robust and there is much uncertainty about the longer term benefits of antipsychotics. Substantial progress has been made in the development and assessment of adjunctive psychosocial interventions. Long-term maintenance and possibly acute stabilisation of depression can be enhanced by the combination of psychosocial treatments with drugs. The development of future treatments should consider both the neurobiological and psychosocial mechanisms underlying the disorder. We should continue to repurpose treatments and to recognise the role of serendipity. We should also investigate optimum combinations of pharmacological and psychotherapeutic treatments at different stages of the illness. Clarification of the mechanisms by which different treatments affect sleep and circadian rhythms and their relation with daily mood fluctuations is likely to help with the treatment selection for individual patients. To be economically viable, existing psychotherapy protocols need to be made briefer and more efficient for improved scalability and sustainability in widespread implementation.

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Twelve-Month Outcome After a First Hospitalization for Affective Psychosis

Abstract: Few patients achieved a favorable outcome in the year after a first hospitalization for an affective psychosis. Low socioeconomic status, poor premorbid function, treatment noncompliance, and substance abuse were associated with lower rates or delayed onset of recovery.

Cited by 276 publications

References 38 publications

MRI Analysis of the Cerebellum in Bipolar Disorder A Pilot Study

MRI Analysis of the Cerebellum in Bipolar Disorder A Pilot Study

Early stages of bipolar disorder: characterization and strategies for early intervention

The Treatment of Bipolar Disorder

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