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The writing on the wall
It was a bright and sunny start to day two of ECNP 2014 and for this correspondent, the morning was spent taking in a compelling line-up of poster presentations.
In a retrospective study of the medical charts of 171 patients with bipolar I, Dr Im Hee Shim and his team showed marked clinical differences in the form of a more severe illness course in patients with subsyndromal depressive symptoms in bipolar mania, compared with those experiencing depressive symptoms alone.1
Despite these differences, there appeared to be no significant differences in treatment, hinting at the need for a more tailored approach to treatment that considers the potentially detrimental impact of mixed symptoms.
Dr Shim’s research also provided further evidence that young, female patients with a family history of bipolar I and a history of suicide have the highest risk of any patient group of developing mixed symptoms.
Model behaviour2
The unpredictability of bipolar I and its symptoms, can be one of the toughest parts of the disorder for patients to deal with, making recent advances in staging models a welcome addition to the clinical armamentarium.
In their poster session Staging of bipolar disorder using disability, functioning and inter-episode recovery, Dr Erik Joas and his colleagues from the University of Gothenburg provided evidence to support the already established theoretical models of bipolar I staging, linking indicators of functioning and the length of time for episode recovery to clinical stages in bipolar I disorder.
Interestingly, Dr Joas’s results showed a relationship between the later stages of bipolar I and the presence of neurogenerative biomarkers in the cerebrospinal fluid, adding weight to the already hefty amount of evidence linking progression of the disorder to biological, neurodegenerative changes in the brain.
Dual-pronged approach3
Bipolar I is a complex disorder that can manifest in a myriad of ways, and as such, often requires more than just a single approach or therapy to guarantee the best chance of successful treatment. In fact, most guidelines recommend combined pharmacological and psychological (such as psychoeducation) for patients diagnosed with bipolar I disorder.
Dr Sagar Parikh and colleagues presented the first randomised, controlled, longitudinal data in Canadian patients to support this approach in their poster ‘Combined treatment: Impact of optimal psychotherapy and medication in bipolar disorder’.
Dr Parikh and his team found that combining some form of psychoeducation with pharmacologic therapy according to the CANMAT4 guidelines led to the best outcomes in patients with bipolar I.
The study showed that patients treated with combined therapy were well for the majority of the time (2/3 of the study period), although mood symptoms still fluctuated, worsening approximately every 3 months.
It is clear that these studies demonstrate just how high the calibre of research is which is being undertaken in this difficult therapeutic area. These insightful forays lead this correspondent to postulate, how much further will the next advancement take us into understanding the challenging psychiatric condition of bipolar I disorder?
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Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
1. Shim IH and Bae DS. Eur Neuropsychopharmacol. 2014;24(Suppl 2):S421.
2. Joas E, et al. Eur Neuropsychopharmacol. 2014;24(Suppl 2):S422.
3. Parikh S, et al. Eur Neuropsychopharmacol. 2014;24(Suppl 2):S422.
4. Yatham LN, et al. Bipolar Disord. 2013; 15: 1-44