The World Federation of Societies of Biological Psychiatry (WFSBP)
Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania
HEINZ GRUNZE1,2, EDUARD VIETA3, GUY M. GOODWIN4, CHARLES BOWDEN5,
RASMUS W. LICHT6, HANS-JURGEN MOLLER2, SIEGFRIED KASPER7 &
WFSBP TASK FORCE ON TREATMENT GUIDELINES FOR BIPOLAR DISORDERS 8*
Abstract
These updated guidelines are based on a first edition that was published in 2003, and have been edited and updated with the available scientific evidence until end of 2008. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute mania in adults. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (A_F). As these guidelines are intended for clinical use, the scientific evidence was finally asigned different grades of recommendation to ensure practicability.
World Journal of Biological Psychiatry,10:2,85 — 116
First Published:May2009
sábado, 24 de octubre de 2009
EVENTOS ROSAVIENTOS
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-En el marco de Próximo Congreso Patogónico de Abordaje de las Adicciones a realizarse en la ciudad Chubutense de Esquel el 5 y 6 de noviembre de 2009, en coordinación con los Profesionales de HAMSA NEUROCIENCIA: Dr Exequiel Baravalle, Dra Marina Bergoglio y Lic Leonardo Aballay, LA ROSA DE LOS VIENTOS se hara presente a traves del Dr Ricardo García.-En dicho evento se realizaran ponencias relacionadas con Benzodiazepinas: generalidades, dependencia y uso racional, y talleres sobre el modelo de abordaje en adicciones.
-El agradecimiento de toda la delegación que viaja desde Córdoba a la invitación del GOBIERNO DE CHUBUT a través de su DIRECCION DE PREVENCION Y ASISTENCIA A LAS ADICCIONES y a la desinteresada intermediación de la Lic. Virginia Conci desde Puerto Madryn, para que esto sea posible.
miércoles, 30 de septiembre de 2009
CAFE, CIGARRILLO Y SUICIDIO
Original Article
Coffee and cigarette use: association with
suicidal acts in 352 Sardinian bipolar disorder
patients
Baethge C, Tondo L, Lepri B, Baldessarini RJ.
Objective: Abuse of illicit drugs and alcohol is prevalent in bipolar disorder (BPD) patients, and is an adverse prognostic factor. Much less is known about correlates of nicotine and caffeine consumption, but tobacco smoking is tentatively associated with suicidal behavior.
Methods: Retrospective analysis of demographic and clinical factors among 352 longitudinally assessed DSM-IV types I and II BPD patients contrasted patients with versus without consumption of nicotine or caffeine, based on univariate comparisons and multiple regression modeling.
Results: Current smoking (46%) and coffee drinking (74% of cases) were common, and significantly and independently associated with suicidal acts [coffee: odds ratio (OR) = 2.42, 95% confidence interval (CI): 1.15–5.09; smoking: OR = 1.79, CI: 1.02–3.15; both p < rs =" 0.383;" rs =" 0.312;" p =" 0.008)."
Conclusions: This is the first report to associate suicidal acts with coffee consumption in BPD patients, and it confirmed an association with smoking. Pending further evidence, the findings underscore the importance of monitoring use of even legal and mildly psychotropic substances by BPD patients.
Coffee and cigarette use: association with suicidal acts in 352 Sardinian bipolar disorder patients.
Bipolar Disord 2009: 11: 494–503. ª 2009 The Authors. Journal compilation ª 2009 John Wiley & Sons A ⁄ S.
Coffee and cigarette use: association with
suicidal acts in 352 Sardinian bipolar disorder
patients
Baethge C, Tondo L, Lepri B, Baldessarini RJ.
Objective: Abuse of illicit drugs and alcohol is prevalent in bipolar disorder (BPD) patients, and is an adverse prognostic factor. Much less is known about correlates of nicotine and caffeine consumption, but tobacco smoking is tentatively associated with suicidal behavior.
Methods: Retrospective analysis of demographic and clinical factors among 352 longitudinally assessed DSM-IV types I and II BPD patients contrasted patients with versus without consumption of nicotine or caffeine, based on univariate comparisons and multiple regression modeling.
Results: Current smoking (46%) and coffee drinking (74% of cases) were common, and significantly and independently associated with suicidal acts [coffee: odds ratio (OR) = 2.42, 95% confidence interval (CI): 1.15–5.09; smoking: OR = 1.79, CI: 1.02–3.15; both p < rs =" 0.383;" rs =" 0.312;" p =" 0.008)."
Conclusions: This is the first report to associate suicidal acts with coffee consumption in BPD patients, and it confirmed an association with smoking. Pending further evidence, the findings underscore the importance of monitoring use of even legal and mildly psychotropic substances by BPD patients.
Coffee and cigarette use: association with suicidal acts in 352 Sardinian bipolar disorder patients.
Bipolar Disord 2009: 11: 494–503. ª 2009 The Authors. Journal compilation ª 2009 John Wiley & Sons A ⁄ S.
EVENTOS ROSAVIENTOS
VII CONGRESO INTERNACIONAL DE PREVENCIÓN
Y ASISTENCIA DE LA DROGADEPENCENCIA
CORDOBA. ARGENTINA
CORDOBA. ARGENTINA
8, 9 y 10 de Octubre de 2009
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En el marco del Congreso Internacional Organizado por el Programa Cambio, el día viernes 9 de octubre a las 11.00 Hs el Dr Ricardo García, junto a colegas de HAMSA NEUROCIENCIAS, Dr Exequiel Baravalle y la Dra Marina Bergoglio, expondrán sobre Benzodiazepinas, conceptos generales, dependencia y uso racional.
.
Por su parte la Lic Claudia Sosa, en representación del PROGRAMA DEL SOL, junto a la Lic María Teresa Fernadez Alvarez, expondran sobre "Una experiencia de prevención inespecífica del consumo de drogas en el nivel medio. Reformulación del acuerdo de convivencia" el día sabado 10 de Octubre a las 11.30 Hs.
domingo, 9 de agosto de 2009
ISBD. Reporte de Expertos
The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders
Tohen, M.; Frank, E.; Bowden, C.L.; Colom, F.; Ghaemi, S.N.; Yatham, L.N.; Malhi, G.S.; Calabrese, J.R.; Nolen, W.A.; Vieta, E.; Kapczinski, F.; Goodwin, G.M.; Suppes, T.; Sachs, G.S.; Chengappa, K.N.R.; Grunze, H.; Mitchell, P.B.; Kanba, S.; Berk, M.
Bipolar Disorders Vol: 11 Nro: 5 Págs: 453 - 473 Fecha: 01/08/2009
Resumen
Objectives: Via an international panel of experts, this paper attempts to document, review, interpret, and propose operational definitions used to describe the course of bipolar disorders for worldwide use, and to disseminate consensus opinion, supported by the existing literature, in order to better predict course and treatment outcomes.
Methods: Under the auspices of the International Society for Bipolar Disorders, a task force was convened to examine, report, discuss, and integrate findings from the scientific literature related to observational and clinical trial studies in order to reach consensus and propose terminology describing course and outcome in bipolar disorders.
Results: Consensus opinion was reached regarding the definition of nine terms (response, remission, recovery, relapse, recurrence, subsyndromal states, predominant polarity, switch, and functional outcome) commonly used to describe course and outcomes in bipolar disorders. Further studies are needed to validate the proposed definitions.
Conclusion: Determination and dissemination of a consensus nomenclature serve as the first step toward producing a validated and standardized system to define course and outcome in bipolar disorders in order to identify predictors of outcome and effects of treatment. The task force acknowledges that there is limited validity to the proposed terms, as for the most part they represent a consensus opinion. These definitions need to be validated in existing databases and in future studies, and the primary goals of the task force are to stimulate research on the validity of proposed concepts and further standardize the technical nomenclature.
Bipolar Disord 2009: 11: 453–473. (C)2009 The Authors.
Journal compilation (C) 2009 John Wiley & Sons A ⁄ S.
Tohen, M.; Frank, E.; Bowden, C.L.; Colom, F.; Ghaemi, S.N.; Yatham, L.N.; Malhi, G.S.; Calabrese, J.R.; Nolen, W.A.; Vieta, E.; Kapczinski, F.; Goodwin, G.M.; Suppes, T.; Sachs, G.S.; Chengappa, K.N.R.; Grunze, H.; Mitchell, P.B.; Kanba, S.; Berk, M.
Bipolar Disorders Vol: 11 Nro: 5 Págs: 453 - 473 Fecha: 01/08/2009
Resumen
Objectives: Via an international panel of experts, this paper attempts to document, review, interpret, and propose operational definitions used to describe the course of bipolar disorders for worldwide use, and to disseminate consensus opinion, supported by the existing literature, in order to better predict course and treatment outcomes.
Methods: Under the auspices of the International Society for Bipolar Disorders, a task force was convened to examine, report, discuss, and integrate findings from the scientific literature related to observational and clinical trial studies in order to reach consensus and propose terminology describing course and outcome in bipolar disorders.
Results: Consensus opinion was reached regarding the definition of nine terms (response, remission, recovery, relapse, recurrence, subsyndromal states, predominant polarity, switch, and functional outcome) commonly used to describe course and outcomes in bipolar disorders. Further studies are needed to validate the proposed definitions.
Conclusion: Determination and dissemination of a consensus nomenclature serve as the first step toward producing a validated and standardized system to define course and outcome in bipolar disorders in order to identify predictors of outcome and effects of treatment. The task force acknowledges that there is limited validity to the proposed terms, as for the most part they represent a consensus opinion. These definitions need to be validated in existing databases and in future studies, and the primary goals of the task force are to stimulate research on the validity of proposed concepts and further standardize the technical nomenclature.
Bipolar Disord 2009: 11: 453–473. (C)2009 The Authors.
Journal compilation (C) 2009 John Wiley & Sons A ⁄ S.
Nuevos Enfoques Acerca del Uso de los Antidepresivos
¿Por qué los antidepresivos no son antidepresivos?
STEP-BD, STAR*D y el retorno de la depresión neurótica
Nassir Ghaemi, S.
Bipolar Disorder 2008, 10 de diciembre, 8: 957-968
La opinión clínica ampliamente difundida de los “antidepresivos” como altamente efectivos y específicos para el tratamiento de todos los tipos de trastornos depresivos es exagerada. Esta conclusión aleccionadora se basa en los recientes hallazgos de los proyectos STEP-BD y STAR*D patrocinados por NIMH. Los antidepresivos tienen una eficacia a corto plazo limitada en trastornos depresivos unipolares y menor en la depresión bipolar aguda. Su efectividad preventiva a largo plazo es incierta en la depresión mayor recurrente y dudosa en la depresión bipolar recurrente. Estas limitaciones, pueden, en parte, reflejar el concepto excesivamente amplio de depresión mayor, así como generar expectativas poco realistas sobre la eficacia general de fármacos considerados “antidepresivos”.
La depresión refractaria al tratamiento puede revelar el fracaso para distinguir las enfermedades depresivas, en particular, el trastorno bipolar que es intrínsecamente menos sensible a los antidepresivos. Probablemente los antidepresivos deberían ser evitados en la depresión bipolar, estados mixtos depresivo-maníacos y en la depresión neurótica.
Las expectativas de antidepresivos para tipos específicos de pacientes con síntomas de depresión o ansiedad requieren una reevaluación crítica. El resurgimiento del concepto de depresión neurótica posibilitaría la identificación de pacientes con distimia y ansiedad de leve a moderada, crónica o episódica que es improbable que se beneficien mucho con los antidepresivos. Los criterios diagnósticos para la reactivación del concepto de depresión neurótica están propuestos.
STEP-BD, STAR*D y el retorno de la depresión neurótica
Nassir Ghaemi, S.
Bipolar Disorder 2008, 10 de diciembre, 8: 957-968
La opinión clínica ampliamente difundida de los “antidepresivos” como altamente efectivos y específicos para el tratamiento de todos los tipos de trastornos depresivos es exagerada. Esta conclusión aleccionadora se basa en los recientes hallazgos de los proyectos STEP-BD y STAR*D patrocinados por NIMH. Los antidepresivos tienen una eficacia a corto plazo limitada en trastornos depresivos unipolares y menor en la depresión bipolar aguda. Su efectividad preventiva a largo plazo es incierta en la depresión mayor recurrente y dudosa en la depresión bipolar recurrente. Estas limitaciones, pueden, en parte, reflejar el concepto excesivamente amplio de depresión mayor, así como generar expectativas poco realistas sobre la eficacia general de fármacos considerados “antidepresivos”.
La depresión refractaria al tratamiento puede revelar el fracaso para distinguir las enfermedades depresivas, en particular, el trastorno bipolar que es intrínsecamente menos sensible a los antidepresivos. Probablemente los antidepresivos deberían ser evitados en la depresión bipolar, estados mixtos depresivo-maníacos y en la depresión neurótica.
Las expectativas de antidepresivos para tipos específicos de pacientes con síntomas de depresión o ansiedad requieren una reevaluación crítica. El resurgimiento del concepto de depresión neurótica posibilitaría la identificación de pacientes con distimia y ansiedad de leve a moderada, crónica o episódica que es improbable que se beneficien mucho con los antidepresivos. Los criterios diagnósticos para la reactivación del concepto de depresión neurótica están propuestos.
miércoles, 24 de junio de 2009
Trastorno Bipolar. Hipomania Disfórica
HACIA LA DELINEACION CLINICA DE LA HIPOMANIA DISFORICA.
DILEMAS OPERACIONALES Y CONCEPTUALES.
Original Article
Toward a clinical delineation of dysphoric hypomania – operational and conceptual dilemmas
Akiskal HS, Benazzi F.
Bipolar Disord 2005: 7: 456–464. ©
Blackwell Munksgaard, 2005
Objective: Unlike dysphoric mania, we are unaware of any formal studies of dysphoric hypomania (DH). For this reason, DH is not formally recognized by DSM-IV and ICD-10. Analogous to the DSM-IV approach in the diagnosis of manic mixed state, in this exploratory study we operationalized DH as coexisting full syndromal hypomanic and major depressive states.
Methods: In an Italian outpatient private practice setting, 320 BP-II outpatients [meeting DSM-IV criteria except for shorter (>2 days) floor duration for history of hypomanic episodes] were further interviewed with the modified SCID-CV for the simultaneous presence of hypomanic and depressive signs and symptoms during the index presenting affective episode or its exacerbation. Hypomania always included irritable mood plus at least four hypomanic signs and symptoms. Such non-euphoric hypomania had to last at least 1 week.
Results: Only 45 (14.0%) met our proposed criteria for DH. Less stringently defined depressive mixed states (DMX) were excluded from further analyses. When compared with 120 of the 320 (37.5%) “pure” BP-II (i.e., not meeting mixed state criteria), DH emerged as an irritable affective state, demonstrated a significantly higher rate of females, mood lability, racing/crowded thoughts, distractibility, increased talkativeness, psychomotor agitation, and increased goal-directed drives. Psychomotor agitation/activation had a specificity of 87% and sensitivity of 94%, correctly classifying 92% of cases of DH.
Conclusions: The DSM-IV concept of dysphoric manic mixed state can be extended to DH. In the latter, eutrophic exuberance is replaced by irritable-labile mood, and the hypomanic expansiveness finds expression in mental, psychomotor and behavioral activation that could involve increased drives (e.g., travel, substances, and sex) and social disinhibition. It is useful to contrast the foregoing picture of DH as
hypomanic exuberance muted by leaden paralysis, with that of our previous work on DMX as a major depressive mixed state with more subtle excitatory hypomanic intrusions. We discuss methodologic, theoretical and practical implications of categorical (DH) and dimensional (DMX) conceptualizations of mixed states beyond mania.
Hagop S Akiskal a,b and Franco Benazzi c
a International Mood Center, University of California
at San Diego, La Jolla,
b VA Medical Center, San Diego, CA, USA,
c Outpatient Psychiatry Private Center (Ewald Hecker Center), Ravenna, Italy
Key words: bipolar II disorder – dysphoric
hypomania – major depression – mixed state
Received 16 June 2004, revised and accepted for publication 19 June 2005
Corresponding author: Hagop S Akiskal, MD,
International Mood Center, University of California
at San Diego, 3350 La Jolla Village Dr (116-A), San
Diego, CA 92161, USA. Fax: 858 534 8598;
e-mail: hakiskal@ucsd.edu
DILEMAS OPERACIONALES Y CONCEPTUALES.
Original Article
Toward a clinical delineation of dysphoric hypomania – operational and conceptual dilemmas
Akiskal HS, Benazzi F.
Bipolar Disord 2005: 7: 456–464. ©
Blackwell Munksgaard, 2005
Objective: Unlike dysphoric mania, we are unaware of any formal studies of dysphoric hypomania (DH). For this reason, DH is not formally recognized by DSM-IV and ICD-10. Analogous to the DSM-IV approach in the diagnosis of manic mixed state, in this exploratory study we operationalized DH as coexisting full syndromal hypomanic and major depressive states.
Methods: In an Italian outpatient private practice setting, 320 BP-II outpatients [meeting DSM-IV criteria except for shorter (>2 days) floor duration for history of hypomanic episodes] were further interviewed with the modified SCID-CV for the simultaneous presence of hypomanic and depressive signs and symptoms during the index presenting affective episode or its exacerbation. Hypomania always included irritable mood plus at least four hypomanic signs and symptoms. Such non-euphoric hypomania had to last at least 1 week.
Results: Only 45 (14.0%) met our proposed criteria for DH. Less stringently defined depressive mixed states (DMX) were excluded from further analyses. When compared with 120 of the 320 (37.5%) “pure” BP-II (i.e., not meeting mixed state criteria), DH emerged as an irritable affective state, demonstrated a significantly higher rate of females, mood lability, racing/crowded thoughts, distractibility, increased talkativeness, psychomotor agitation, and increased goal-directed drives. Psychomotor agitation/activation had a specificity of 87% and sensitivity of 94%, correctly classifying 92% of cases of DH.
Conclusions: The DSM-IV concept of dysphoric manic mixed state can be extended to DH. In the latter, eutrophic exuberance is replaced by irritable-labile mood, and the hypomanic expansiveness finds expression in mental, psychomotor and behavioral activation that could involve increased drives (e.g., travel, substances, and sex) and social disinhibition. It is useful to contrast the foregoing picture of DH as
hypomanic exuberance muted by leaden paralysis, with that of our previous work on DMX as a major depressive mixed state with more subtle excitatory hypomanic intrusions. We discuss methodologic, theoretical and practical implications of categorical (DH) and dimensional (DMX) conceptualizations of mixed states beyond mania.
Hagop S Akiskal a,b and Franco Benazzi c
a International Mood Center, University of California
at San Diego, La Jolla,
b VA Medical Center, San Diego, CA, USA,
c Outpatient Psychiatry Private Center (Ewald Hecker Center), Ravenna, Italy
Key words: bipolar II disorder – dysphoric
hypomania – major depression – mixed state
Received 16 June 2004, revised and accepted for publication 19 June 2005
Corresponding author: Hagop S Akiskal, MD,
International Mood Center, University of California
at San Diego, 3350 La Jolla Village Dr (116-A), San
Diego, CA 92161, USA. Fax: 858 534 8598;
e-mail: hakiskal@ucsd.edu
martes, 2 de junio de 2009
Trastorno Bipolar y Tabaco
Original Article
Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression
Diaz FJ, James D, Botts S, Maw L, Susce MT, de Leon J.
Objectives: This study compared the prevalence of tobacco smoking behaviors in patients with bipolar disorder with normal and psychiatric (schizophrenia and major depression) controls. The main goal was to establish that bipolar patients smoke more than normal controls. Differences with psychiatric controls were explored.
Methods: Samples of 424 patients (99 bipolar, 258 schizophrenia and 67 major depression) and 402 volunteer controls were collected in Central Kentucky. Smoking data for Kentucky_s general population were available. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to establish the strength of associations. Logistic regression was used to adjust ORs for confounding variables.
Results: Using epidemiological definitions of smoking behaviors and the general population as controls provided bipolar disorder unadjusted ORs of 5.0 (95% CI: 3.3–7.8) for current cigarette smoking, 2.6 (95% CI: 1.7–4.4) for ever cigarette smoking, and 0.13 (95% CI: 0.03–0.24) for smoking cessation. Using a clinical definition and volunteers as controls provided respective bipolar disorder adjusted ORs of 7.3 (95% CI: 4.3–12.4), 4.0 (95% CI: 2.4–6.7), and 0.15 (95% CI: 0.06–0.36). Prevalences of current daily smoking for patients with major depression, bipolar disorder, and schizophrenia were 57%, 66%, and 74%, respectively.
Conclusions: Bipolar disorder was associated with significantly higher prevalences of tobacco smoking behaviors compared with the general population or volunteer controls, independently of the definition used. It is possible that smoking behaviors in bipolar disorder may have intermediate prevalences between major depression and schizophrenia,
but larger samples or a combination of multiple studies (meta-analysis) will be needed to establish whether this hypothesis is correct.
Francisco J Diaz 1, Danielle James 2, Sheila Botts 2, Lorraine Maw 2,
Margaret T Susce 2 and Jose de Leon 2,3
1 Department of Statistics, Universidad Nacional, Medellin, Colombia,
2 University of Kentucky, Mental Health Research Center at Eastern State Hospital,
Lexington, KY, USA,
3 Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences,
University of Granada, Granada, Spain
Corresponding author: Jose de Leon, MD, Mental Health Research Center at Eastern State Hospital, 627 West Fourth Street, Lexington, KY 40508, USA.
Fax: 859-246-7019;
e-mail: jdeleon@uky.edu
Received 7 April 2008, revised and accepted for publication 20 June 2008
Bipolar Disord 2009: 11: 154–165. © 2009
The Authors Journal compilation © 2009
Blackwell Munksgaard
Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression
Diaz FJ, James D, Botts S, Maw L, Susce MT, de Leon J.
Objectives: This study compared the prevalence of tobacco smoking behaviors in patients with bipolar disorder with normal and psychiatric (schizophrenia and major depression) controls. The main goal was to establish that bipolar patients smoke more than normal controls. Differences with psychiatric controls were explored.
Methods: Samples of 424 patients (99 bipolar, 258 schizophrenia and 67 major depression) and 402 volunteer controls were collected in Central Kentucky. Smoking data for Kentucky_s general population were available. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used to establish the strength of associations. Logistic regression was used to adjust ORs for confounding variables.
Results: Using epidemiological definitions of smoking behaviors and the general population as controls provided bipolar disorder unadjusted ORs of 5.0 (95% CI: 3.3–7.8) for current cigarette smoking, 2.6 (95% CI: 1.7–4.4) for ever cigarette smoking, and 0.13 (95% CI: 0.03–0.24) for smoking cessation. Using a clinical definition and volunteers as controls provided respective bipolar disorder adjusted ORs of 7.3 (95% CI: 4.3–12.4), 4.0 (95% CI: 2.4–6.7), and 0.15 (95% CI: 0.06–0.36). Prevalences of current daily smoking for patients with major depression, bipolar disorder, and schizophrenia were 57%, 66%, and 74%, respectively.
Conclusions: Bipolar disorder was associated with significantly higher prevalences of tobacco smoking behaviors compared with the general population or volunteer controls, independently of the definition used. It is possible that smoking behaviors in bipolar disorder may have intermediate prevalences between major depression and schizophrenia,
but larger samples or a combination of multiple studies (meta-analysis) will be needed to establish whether this hypothesis is correct.
Francisco J Diaz 1, Danielle James 2, Sheila Botts 2, Lorraine Maw 2,
Margaret T Susce 2 and Jose de Leon 2,3
1 Department of Statistics, Universidad Nacional, Medellin, Colombia,
2 University of Kentucky, Mental Health Research Center at Eastern State Hospital,
Lexington, KY, USA,
3 Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences,
University of Granada, Granada, Spain
Corresponding author: Jose de Leon, MD, Mental Health Research Center at Eastern State Hospital, 627 West Fourth Street, Lexington, KY 40508, USA.
Fax: 859-246-7019;
e-mail: jdeleon@uky.edu
Received 7 April 2008, revised and accepted for publication 20 June 2008
Bipolar Disord 2009: 11: 154–165. © 2009
The Authors Journal compilation © 2009
Blackwell Munksgaard
martes, 26 de mayo de 2009
martes, 28 de abril de 2009
Rendimiento Neuropsicologico como predictor de recuperación clínica en pacientes bipolares
Brief report
Neuropsychological performance predicts clinical recovery in bipolar patients
Staci A. Gruber ., Isabelle M. Rosso, Deborah Yurgelun-Todd
Cognitive Neuroimaging Laboratory, Brain Imaging Center, McLean Hospital, and Department of Psychiatry, Harvard Medical School,
115 Mill Street, Belmont, MA 02478, USA
Received 6 October 2006; received in revised form 30 March 2007; accepted 18 April 2007
Available online 23 May 2007
Abstract
Background: Although a number of investigations have reported cognitive deficits in patients with bipolar disorder, relatively few have focused on the relationship between these impairments and clinical outcome.
Methods: In order to help clarify the pattern of and extent to which cognitive deficits are present at the onset of illness and their relationship to outcome, we examined 26 bipolar patients during their first hospitalization and 20 psychiatrically healthy control subjects. All subjects completed tests of frontal/executive control, psychomotor speed and memory function at baseline and selfreports of clinical recovery (time to recover in days) at 12 months post study enrollment.
Results: At baseline, first episode bipolar patients demonstrated greater deficits relative to control subjects on neurocognitive measures, and a significant association was detected between time to recover and performance on a measure of frontal/executive function (interference condition of the Stroop; p=.05; derived interference: p=.04). A trend towards significance was also demonstrated between time to clinical recovery and verbal fluency ( p=.06).
Conclusions: These findings indicate that neuropsychological deficits are seen early in the course of bipolar disorder, prior to the effects of multiple or prolonged episodes, and may be associated with clinical outcome. Future studies are needed to determine whether
changes in inhibitory processing or other cognitive function predict clinical outcome or are associated with treatment response.
© 2007 Elsevier B.V. All rights reserved.
Keywords: Bipolar; Neurocognition; Recovery; Inhibitory function; Stroop
Neuropsychological performance predicts clinical recovery in bipolar patients
Staci A. Gruber ., Isabelle M. Rosso, Deborah Yurgelun-Todd
Cognitive Neuroimaging Laboratory, Brain Imaging Center, McLean Hospital, and Department of Psychiatry, Harvard Medical School,
115 Mill Street, Belmont, MA 02478, USA
Received 6 October 2006; received in revised form 30 March 2007; accepted 18 April 2007
Available online 23 May 2007
Abstract
Background: Although a number of investigations have reported cognitive deficits in patients with bipolar disorder, relatively few have focused on the relationship between these impairments and clinical outcome.
Methods: In order to help clarify the pattern of and extent to which cognitive deficits are present at the onset of illness and their relationship to outcome, we examined 26 bipolar patients during their first hospitalization and 20 psychiatrically healthy control subjects. All subjects completed tests of frontal/executive control, psychomotor speed and memory function at baseline and selfreports of clinical recovery (time to recover in days) at 12 months post study enrollment.
Results: At baseline, first episode bipolar patients demonstrated greater deficits relative to control subjects on neurocognitive measures, and a significant association was detected between time to recover and performance on a measure of frontal/executive function (interference condition of the Stroop; p=.05; derived interference: p=.04). A trend towards significance was also demonstrated between time to clinical recovery and verbal fluency ( p=.06).
Conclusions: These findings indicate that neuropsychological deficits are seen early in the course of bipolar disorder, prior to the effects of multiple or prolonged episodes, and may be associated with clinical outcome. Future studies are needed to determine whether
changes in inhibitory processing or other cognitive function predict clinical outcome or are associated with treatment response.
© 2007 Elsevier B.V. All rights reserved.
Keywords: Bipolar; Neurocognition; Recovery; Inhibitory function; Stroop
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