Bipolar Disorder: Psychosis, Mania, and Additional Research

“Psychosis can happen out of the blue, to anyone, and no one knows why. Not even the best doctors on the planet.”
― Author Jeannine Garsee, The Unquiet

A team of international experts called for better care and more research into treatments for persons who have a first manic episode, suggesting their care has been overlooked compared with care for patients with other nonaffective psychoses. Outlining the epidemiology of first-episode mania in the context of bipolar disorder; the natural history of mania; current evidence for pharmacological, psychological, and service-level interventions; and current guidelines for treatment, they asked for clearer guidelines and targeted care within existing services.

A study was conducted to predict the severity of behavioral traits and symptoms associated with risk of bipolar spectrum disorder from patterns of whole-brain activation during reward expectancy. Functional neuroimaging data were acquired from 2 independent samples of transdiagnostically recruited adults. The model significantly predicted severity of a specific hypo/mania-related symptom, heightened energy. The findings could provide neural biomarkers for early identification of individual-level bipolar disorder risk in young adults.

Efficacy and safety are equally important in the choice of atypical antipsychotics, reported psychiatric pharmacists and psychiatrists in a recent survey. While 64.3% rated effectiveness and safety as equals, 26.2% favored safety and 9.4% favored effectiveness. The medication properties most important for bipolar disorder were reducing manic episodes (87.8%), episode relapse (53.7%), and hospitalizations (53.7%). Restrictions affected antipsychotic choice at 80.5% of sites and were thought to affect adherence (55.0%) and outcomes (53.4%).

Patients with major depressive disorder (MDD), bipolar disorder, or schizophrenia who attempt suicide carry a greater genetic liability for major depression than those who do not. In the largest genome-wide association study on suicide attempt, polygenic risk scores for major depression were significantly associated with suicide attempt in MDD (R2=0.25%), bipolar disorder (R2=0.24%), and schizophrenia (R2=0.40%). The findings demonstrate that genetic liability for major depression increases risk of suicide attempt across psychiatric disorders.

Quality of life in patients with MDD in remission and patients with bipolar disorder in remission is inferior to that of the normal population, more so in those with MDD, a study showed. Marital status was associated with increased quality of life in patients with MDD but not in those with bipolar disorder; quality of life was decreased by residual symptoms related to depression or anxiety in both disorders. The authors suggested that quality of life of patients with mood disorders merits more attention, even during euthymic periods.

A majority of surveyed patients with bipolar disorder said they use providers and internet-based resources as their main information sources. Time constraints and fast-paced information dissemination in the provider’s office were cited as barriers to successful provider-patient interactions, and patients who used Web-based channels said Web information was more helpful than provider-based information. The authors recommended exploration of how high-quality Web sites could be used to help patients and improve provider-patient interactions.