Highs and Lows in New Bipolar Research

A recent 20-year studyof patients diagnosed with either schizophrenia or bipolar disorder found that the overall mortality rate was >4 times higher for patients with schizophrenia and >2.5 times higher for those with bipolar disorder vs the general population. Increases in the standardized mortality ratios for these disorders over time were similar for patients with schizophrenia (4.58) and patients with bipolar disorder (2.57), suggesting similar underlying factors influencing mortality rates.

A Scottish study of patients with bipolar disorder between 2009 and 2016, found that antidepressant monotherapy was the most common form of treatment with approximately 25% of patients receiving it as their modal treatment vs approximately 6% of patients who received lithium monotherapy. There was an increase in antipsychotic (11.65%) and antiepileptic (52.89%) prescriptions and a 15.51% decrease in lithium prescriptions; valproate prescribing decreased in women but increased in men. The authors concluded that these findings signify a concerning gap between treatment guidelines and clinical practice.

Patients with bipolar disorder type II in a recent smartphone-based monitoring study experienced more mood instability during depression vs those with bipolar disorder type I, although the intensity of their manic symptoms was lower. Patients with bipolar disorder type II did not experience lower mean mood or higher intensity of depressive symptoms vs patients with bipolar disorder type I. The researchers concluded, however, that further studies examining the impact of treatment on mood instability are still needed.

In addressing concerns about the capacity of antidepressants for bipolar depression to cause affective switching or mood destabilization, a 2018 review of various studies on bipolar depression noted that when added to mood stabilizers, antidepressants were not linked with increased treatment emergent affective switching and patients with bipolar disorder type II can be safely treated with antidepressants.

The risk of sexually transmitted infections (STIs) is greater in youths who have bipolar disorder than in those who do not. In a recent study of adolescent and young adults who contracted an STI-eg, HIV, syphilis, genital warts, gonorrhea, chlamydial infection, or trichomoniasis-bipolar disorder was an independent risk factor for contracting an STI. Patients with bipolar disorder who also had a substance or alcohol use disorder had the highest risk for contracting an STI, however, long-term use of mood stabilizers and atypical antipsychotics reduced this risk.

The impact of mood episodes on mothering and on the partner were the biggest concerns of perinatal women with bipolar disorder facing the risk of illness relapse postpartum, according to a recent qualitative study. Depression and psychosis were the main illness relapse concerns. The findings favored a psychological and psychosocial focus in perinatal prevention planning and counseling-with assessment of women’s personal risk recognition, perinatal concerns, and available resources and preparations-and providing appropriate support.

In an investigation of brain glucose metabolism, patients with borderline personality disorder and patients with bipolar II disorder both showed hypometabolism in the insula regions, suggesting shared pathophysiological mechanisms. However, patterns of altered metabolism specific to each group suggested differential pathophysiology, although corrected results in the direct comparison between the disorders was nonsignificant.

Self-compassion partially mediated the relationship between maladaptive perfectionism, depression, anxiety, and emotion regulation difficulties among patients with bipolar disorder in a recent study. The authors suggested that self-compassion represents a modifiable treatment target and patients with bipolar disorder who exhibit maladaptive perfectionistic tendencies may benefit from self-compassion interventions.