Bipolar Disorder

Euthymic bipolar disorder patients with poor medication adherence are more likely to experience nonplanning impulsivity, according to Dr. Raoul Belzeaux and his associates.

Dr. Belzeaux and his associates conducted a cross-sectional study at nine centers across France. They collected data from 260 outpatients in symptomatic remission who had been diagnosed with bipolar disorder type I, type II, or not otherwise specified based on DSM-IV criteria.

The Medication Adherence Rating Scale total mean score for the study was 7.6, which is suboptimal. The standardized coefficient between nonplanning impulsivity score and MARS score was 0.156. Factors outside medication adherence, such as lifetime anxiety disorders, had little effect on impulsivity and medication adherence.

“The association between impulsivity and adherence to medication may lead to systematically evaluate impulsivity” for example, with standardized questionnaires such as the Barratt Impulsiveness Scale “in clinical practice to better predict risk of nonadherence and, thus, contribute to promote personalized treatment strategy,” the investigators concluded.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.05.041).

[email protected]

Euthymic bipolar disorder patients with poor medication adherence are more likely to experience nonplanning impulsivity, according to Dr. Raoul Belzeaux and his associates.

Dr. Belzeaux and his associates conducted a cross-sectional study at nine centers across France. They collected data from 260 outpatients in symptomatic remission who had been diagnosed with bipolar disorder type I, type II, or not otherwise specified based on DSM-IV criteria.

The Medication Adherence Rating Scale total mean score for the study was 7.6, which is suboptimal. The standardized coefficient between nonplanning impulsivity score and MARS score was 0.156. Factors outside medication adherence, such as lifetime anxiety disorders, had little effect on impulsivity and medication adherence.

“The association between impulsivity and adherence to medication may lead to systematically evaluate impulsivity” for example, with standardized questionnaires such as the Barratt Impulsiveness Scale “in clinical practice to better predict risk of nonadherence and, thus, contribute to promote personalized treatment strategy,” the investigators concluded.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.05.041).

[email protected]

Euthymic bipolar disorder patients with poor medication adherence are more likely to experience nonplanning impulsivity, according to Dr. Raoul Belzeaux and his associates.

Dr. Belzeaux and his associates conducted a cross-sectional study at nine centers across France. They collected data from 260 outpatients in symptomatic remission who had been diagnosed with bipolar disorder type I, type II, or not otherwise specified based on DSM-IV criteria.

The Medication Adherence Rating Scale total mean score for the study was 7.6, which is suboptimal. The standardized coefficient between nonplanning impulsivity score and MARS score was 0.156. Factors outside medication adherence, such as lifetime anxiety disorders, had little effect on impulsivity and medication adherence.

“The association between impulsivity and adherence to medication may lead to systematically evaluate impulsivity” for example, with standardized questionnaires such as the Barratt Impulsiveness Scale “in clinical practice to better predict risk of nonadherence and, thus, contribute to promote personalized treatment strategy,” the investigators concluded.

Find the full study in the Journal of Affective Disorders (doi: 10.1016/j.jad.2015.05.041).

[email protected]

Both the incidence of bipolar disorder and the standardized mortality ratio of patients with bipolar disorder, compared with the general population, significantly increased, according to a Danish cohort study.

The study was of 15,334 patients with a first-ever diagnosis of bipolar disorder, according to the International Classification of Diseases (ICD)-10 criteria, between Jan. 1, 1995, and Dec. 31, 2012. Patients were followed until Dec. 31, 2012, or death, whichever came first. Data came from the Danish Psychiatric Central Research Register, a national electronic registry containing all psychiatric hospitalizations since 1969 and all psychiatric outpatient contacts and emergency room visits since 1995. Those diagnosed with schizophrenia subsequent to being diagnosed with bipolar disorder and patients who received one of several specific ICD-8 diagnoses before 1995 (when the ICD-8 was in use) were excluded.

Bipolar disorder became significantly more common, especially throughout the 2000s. The total incidence rate was 18.5/100,000 person-years (PY) in 1995 and, at its lowest, was 14.8/100,000 PY in 1997. The most recent and highest incidence of the disorder was 28.4/100,000 PY in 2012. Such findings represent a higher incidence of bipolar disorder than was found in studies conducted in England during the same period, according to Clara Reece Medici of Aarhus University Hospital, in Risskov, Denmark, and her colleagues.

Significantly more females than males were diagnosed with bipolar disorder, with 9,132 females and 6,202 males having suffered from the disease.

Mortality in patients with bipolar disorder was higher, compared with the general population, with the mean standardized mortality ratio (SMR) for patients with bipolar disorder vs. the general population having been 1.7. Deaths of the bipolar patients were mostly tied to natural causes, but as many as 9% of the bipolar patients committed suicide.

Another of the study’s findings was that age at diagnosis of bipolar disorder decreased by more than 10 years, with the average age at diagnosis having been 54.5 in 1995, compared with 42.4 in 2012. The researchers said increased awareness among clinicians may explain this, but that they will test whether “increased use of antidepressants and medication against [attention-deficit/hyperactivity disorder] in Denmark in the same time period may have contributed to unmasking a latent bipolar episode earlier.”

According to the researchers, “studies on lowering physical illlness in patients with bipolar disorder are needed to lower death by natural causes.”

Read the full study in the Journal of Affective Disorders (doi:http://dx.doi.org/10.1016/j.jad.2015.04.032).

[email protected]

Both the incidence of bipolar disorder and the standardized mortality ratio of patients with bipolar disorder, compared with the general population, significantly increased, according to a Danish cohort study.

The study was of 15,334 patients with a first-ever diagnosis of bipolar disorder, according to the International Classification of Diseases (ICD)-10 criteria, between Jan. 1, 1995, and Dec. 31, 2012. Patients were followed until Dec. 31, 2012, or death, whichever came first. Data came from the Danish Psychiatric Central Research Register, a national electronic registry containing all psychiatric hospitalizations since 1969 and all psychiatric outpatient contacts and emergency room visits since 1995. Those diagnosed with schizophrenia subsequent to being diagnosed with bipolar disorder and patients who received one of several specific ICD-8 diagnoses before 1995 (when the ICD-8 was in use) were excluded.

Bipolar disorder became significantly more common, especially throughout the 2000s. The total incidence rate was 18.5/100,000 person-years (PY) in 1995 and, at its lowest, was 14.8/100,000 PY in 1997. The most recent and highest incidence of the disorder was 28.4/100,000 PY in 2012. Such findings represent a higher incidence of bipolar disorder than was found in studies conducted in England during the same period, according to Clara Reece Medici of Aarhus University Hospital, in Risskov, Denmark, and her colleagues.

Significantly more females than males were diagnosed with bipolar disorder, with 9,132 females and 6,202 males having suffered from the disease.

Mortality in patients with bipolar disorder was higher, compared with the general population, with the mean standardized mortality ratio (SMR) for patients with bipolar disorder vs. the general population having been 1.7. Deaths of the bipolar patients were mostly tied to natural causes, but as many as 9% of the bipolar patients committed suicide.

Another of the study’s findings was that age at diagnosis of bipolar disorder decreased by more than 10 years, with the average age at diagnosis having been 54.5 in 1995, compared with 42.4 in 2012. The researchers said increased awareness among clinicians may explain this, but that they will test whether “increased use of antidepressants and medication against [attention-deficit/hyperactivity disorder] in Denmark in the same time period may have contributed to unmasking a latent bipolar episode earlier.”

According to the researchers, “studies on lowering physical illlness in patients with bipolar disorder are needed to lower death by natural causes.”

Read the full study in the Journal of Affective Disorders (doi:http://dx.doi.org/10.1016/j.jad.2015.04.032).

[email protected]

Both the incidence of bipolar disorder and the standardized mortality ratio of patients with bipolar disorder, compared with the general population, significantly increased, according to a Danish cohort study.

The study was of 15,334 patients with a first-ever diagnosis of bipolar disorder, according to the International Classification of Diseases (ICD)-10 criteria, between Jan. 1, 1995, and Dec. 31, 2012. Patients were followed until Dec. 31, 2012, or death, whichever came first. Data came from the Danish Psychiatric Central Research Register, a national electronic registry containing all psychiatric hospitalizations since 1969 and all psychiatric outpatient contacts and emergency room visits since 1995. Those diagnosed with schizophrenia subsequent to being diagnosed with bipolar disorder and patients who received one of several specific ICD-8 diagnoses before 1995 (when the ICD-8 was in use) were excluded.

Bipolar disorder became significantly more common, especially throughout the 2000s. The total incidence rate was 18.5/100,000 person-years (PY) in 1995 and, at its lowest, was 14.8/100,000 PY in 1997. The most recent and highest incidence of the disorder was 28.4/100,000 PY in 2012. Such findings represent a higher incidence of bipolar disorder than was found in studies conducted in England during the same period, according to Clara Reece Medici of Aarhus University Hospital, in Risskov, Denmark, and her colleagues.

Significantly more females than males were diagnosed with bipolar disorder, with 9,132 females and 6,202 males having suffered from the disease.

Mortality in patients with bipolar disorder was higher, compared with the general population, with the mean standardized mortality ratio (SMR) for patients with bipolar disorder vs. the general population having been 1.7. Deaths of the bipolar patients were mostly tied to natural causes, but as many as 9% of the bipolar patients committed suicide.

Another of the study’s findings was that age at diagnosis of bipolar disorder decreased by more than 10 years, with the average age at diagnosis having been 54.5 in 1995, compared with 42.4 in 2012. The researchers said increased awareness among clinicians may explain this, but that they will test whether “increased use of antidepressants and medication against [attention-deficit/hyperactivity disorder] in Denmark in the same time period may have contributed to unmasking a latent bipolar episode earlier.”

According to the researchers, “studies on lowering physical illlness in patients with bipolar disorder are needed to lower death by natural causes.”

Read the full study in the Journal of Affective Disorders (doi:http://dx.doi.org/10.1016/j.jad.2015.04.032).

[email protected]

Recovery-focused cognitive-behavioral therapy can delay and reduce relapses for patients with recent-onset bipolar disorder, Steven H. Jones, Ph.D., and his associates reported in a pilot study that compared 33 patients who received up to 18 hours of tailored CBT and 34 patients who received treatment as usual (TAU).

“This study highlights the potential benefits of taking a formulation-based approach to bipolar disorder, in which a range of evidence-informed techniques are available to the clinician but the relative emphasis given to each is determined on an individual client basis,” the researchers noted in the British Journal of Psychiatry (doi:10.1192/bjp.bp.113.141259).

©Castillo Dominici/Thinkstockphotos.com

Dr. Jones of Lancaster (England) University and his colleagues studied participants who met the DSM-IV diagnosis of primary bipolar with onset within the past 5 years. The recovery-focused CBT approach included core items whose use was determined by individual patient needs. The recovery approach was explained, information was gathered about current and historical mood and functioning, the meaning and relevance of the diagnosis were discussed, recovery-informed therapy goals were identified, relationships between mood experiences and progress towards recovery goals were addressed, CBT techniques were identified and applied to facilitate positive coping, and wider functioning issues in relation to recovery were considered. The information was used to develop a recovery plan and lessons from therapy were shared with key stakeholders.

Unlike standard CBT for bipolar disorder, which focuses on preventing relapse, the tailored CBT approach elicited client-focused goals and the freedom to work within whatever model the client brings. The model could address functioning and comorbidity issues as well as mood problems, and emphasized supporting clients to move away from self-critical and stigmatizing language, especially around diagnosis and behavior in acute episodes.

The primary clinical outcomes were measured using the Bipolar Recovery Questionnaire (33-item version, 0-100 scale with higher score indicating higher personal recovery), time to bipolar relapse measured by the Structural Clinical Interview for DSM-IV (SCID)-LIFE, and mood symptoms as measured by the Hamilton Rating Scale for Depression and Bech-Rafaelsen Mania Scale.

After 12 months, the CBT group’s Bipolar Recovery Questionnaire mean score was 2,351 – a 30% improvement from baseline (1,797), while the TAU group’s mean score was 2,193 – an 8% improvement from baseline(1,935).

Both manic and depressive relapses were less common and took longer to occur in the CBT group. There were 11 depressive relapses in the CBT group, occurring after a median of 60 weeks. There were 19 relapses in the TAU group, occurring after a median of 18 weeks. There were 3 manic relapses in the CBT group, occurring after a median of 60 weeks, and 10 manic relapses in the TAU group occurring after a median of 33 weeks.

[email protected]

Recovery-focused cognitive-behavioral therapy can delay and reduce relapses for patients with recent-onset bipolar disorder, Steven H. Jones, Ph.D., and his associates reported in a pilot study that compared 33 patients who received up to 18 hours of tailored CBT and 34 patients who received treatment as usual (TAU).

“This study highlights the potential benefits of taking a formulation-based approach to bipolar disorder, in which a range of evidence-informed techniques are available to the clinician but the relative emphasis given to each is determined on an individual client basis,” the researchers noted in the British Journal of Psychiatry (doi:10.1192/bjp.bp.113.141259).

©Castillo Dominici/Thinkstockphotos.com

Dr. Jones of Lancaster (England) University and his colleagues studied participants who met the DSM-IV diagnosis of primary bipolar with onset within the past 5 years. The recovery-focused CBT approach included core items whose use was determined by individual patient needs. The recovery approach was explained, information was gathered about current and historical mood and functioning, the meaning and relevance of the diagnosis were discussed, recovery-informed therapy goals were identified, relationships between mood experiences and progress towards recovery goals were addressed, CBT techniques were identified and applied to facilitate positive coping, and wider functioning issues in relation to recovery were considered. The information was used to develop a recovery plan and lessons from therapy were shared with key stakeholders.

Unlike standard CBT for bipolar disorder, which focuses on preventing relapse, the tailored CBT approach elicited client-focused goals and the freedom to work within whatever model the client brings. The model could address functioning and comorbidity issues as well as mood problems, and emphasized supporting clients to move away from self-critical and stigmatizing language, especially around diagnosis and behavior in acute episodes.

The primary clinical outcomes were measured using the Bipolar Recovery Questionnaire (33-item version, 0-100 scale with higher score indicating higher personal recovery), time to bipolar relapse measured by the Structural Clinical Interview for DSM-IV (SCID)-LIFE, and mood symptoms as measured by the Hamilton Rating Scale for Depression and Bech-Rafaelsen Mania Scale.

After 12 months, the CBT group’s Bipolar Recovery Questionnaire mean score was 2,351 – a 30% improvement from baseline (1,797), while the TAU group’s mean score was 2,193 – an 8% improvement from baseline(1,935).

Both manic and depressive relapses were less common and took longer to occur in the CBT group. There were 11 depressive relapses in the CBT group, occurring after a median of 60 weeks. There were 19 relapses in the TAU group, occurring after a median of 18 weeks. There were 3 manic relapses in the CBT group, occurring after a median of 60 weeks, and 10 manic relapses in the TAU group occurring after a median of 33 weeks.

[email protected]

Recovery-focused cognitive-behavioral therapy can delay and reduce relapses for patients with recent-onset bipolar disorder, Steven H. Jones, Ph.D., and his associates reported in a pilot study that compared 33 patients who received up to 18 hours of tailored CBT and 34 patients who received treatment as usual (TAU).

“This study highlights the potential benefits of taking a formulation-based approach to bipolar disorder, in which a range of evidence-informed techniques are available to the clinician but the relative emphasis given to each is determined on an individual client basis,” the researchers noted in the British Journal of Psychiatry (doi:10.1192/bjp.bp.113.141259).

©Castillo Dominici/Thinkstockphotos.com

Dr. Jones of Lancaster (England) University and his colleagues studied participants who met the DSM-IV diagnosis of primary bipolar with onset within the past 5 years. The recovery-focused CBT approach included core items whose use was determined by individual patient needs. The recovery approach was explained, information was gathered about current and historical mood and functioning, the meaning and relevance of the diagnosis were discussed, recovery-informed therapy goals were identified, relationships between mood experiences and progress towards recovery goals were addressed, CBT techniques were identified and applied to facilitate positive coping, and wider functioning issues in relation to recovery were considered. The information was used to develop a recovery plan and lessons from therapy were shared with key stakeholders.

Unlike standard CBT for bipolar disorder, which focuses on preventing relapse, the tailored CBT approach elicited client-focused goals and the freedom to work within whatever model the client brings. The model could address functioning and comorbidity issues as well as mood problems, and emphasized supporting clients to move away from self-critical and stigmatizing language, especially around diagnosis and behavior in acute episodes.

The primary clinical outcomes were measured using the Bipolar Recovery Questionnaire (33-item version, 0-100 scale with higher score indicating higher personal recovery), time to bipolar relapse measured by the Structural Clinical Interview for DSM-IV (SCID)-LIFE, and mood symptoms as measured by the Hamilton Rating Scale for Depression and Bech-Rafaelsen Mania Scale.

After 12 months, the CBT group’s Bipolar Recovery Questionnaire mean score was 2,351 – a 30% improvement from baseline (1,797), while the TAU group’s mean score was 2,193 – an 8% improvement from baseline(1,935).

Both manic and depressive relapses were less common and took longer to occur in the CBT group. There were 11 depressive relapses in the CBT group, occurring after a median of 60 weeks. There were 19 relapses in the TAU group, occurring after a median of 18 weeks. There were 3 manic relapses in the CBT group, occurring after a median of 60 weeks, and 10 manic relapses in the TAU group occurring after a median of 33 weeks.

[email protected]

WASHINGTON – A new bill sponsored by Rep. Tim Murphy (R-Pa.) aims to improve the treatment of serious mental illness by providing access and assistance to families and caregivers, improving mental health and substance abuse treatment parity, and encouraging evidence-based mental health care.

H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, also would increase the number of psychiatric hospital beds for those in acute crisis, allocate funds to mental and behavioral health workforce development, and reform oversight of mental health care delivery.

The bill was originally introduced in the last Congress, after the mass shooting in Newtown, Conn. It is based on the findings of a report commissioned by the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations, which cited high levels of untreated serious mental illness nationwide.

During a June 16 hearing on the bill, Virginia state senator Creigh Deeds, a Democrat, testified about his son’s serious mental illness. Sen. Deeds said that it wasn’t until after his son had stabbed him multiple times, then killed himself, that the senator learned the details of his son’s treatment for bipolar disorder. Those details might have allowed him to successfully intervene and save his son, Sen. Deeds said. The information he did get often came anonymously, he added, due to providers’ fears of violating HIPAA (Health Insurance Portability and Accountability Act).

“HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. Even though I was the one who cared for him, fed him, housed him, transported him, insured him, I was not privy to any information that could clarify for me his behaviors, his treatment plan, and symptoms to be vigilant about,” Sen. Deeds testified. “I was in the dark as I tried to advocate for him in the best way I could with the best information I had.”

H.R. 2646 would amend HIPAA and FERPA (Family Educational Rights and Privacy Act) to allow family members and other caregivers access to diagnoses, treatment plans, and prescribed medications without patient consent. Release of psychotherapy notes would remain prohibited, however.

Meanwhile, patient privacy legislation (H.R. 2690) introduced by Rep. Doris Matsui (D-Calif.) and considered during the same hearing would clarify and strengthen existing language in HIPAA law by amending but not rewriting it. H.R. 2690 would de-escalate the fears of medical personnel surrounding HIPAA, which Rep. Matsui said was appropriately written but not always applied as intended.

Dr. Jeffrey Lieberman*, chair of the psychiatry department at Columbia University, New York, testified that “simply educating doctors” would not be enough to impact how HIPAA-protected information was shared with concerned families because of “the fear of God placed in doctors by personal injury lawyers who often challenge doctors” even when doctors are doing “the common-sense thing to do.”

H.R. 2646 also calls for medical records and mental health records to be integrated. “If a primary care physician doesn’t know that a patient is recovering from an opiate addiction, that provider might misprescribe the patient an opiate and start that patient into a relapse,” Rep. Murphy said in an interview. “Instead of making the files separate but equal, you make them the same. You can’t treat the brain without treating the body.”

The bill also would change the way Medicaid pays for acute care psychiatric services. Currently, under the institutions of mental disease exclusion, federal Medicaid funds can be used for no more than 16 beds in an inpatient psychiatric facility. According to Dr. Lorenzo Norris, director of inpatient psychiatric services at George Washington University Hospital, Washington, D.C., the result is that state-funded facilities often turn away patients experiencing acute mental health crises. H.R. 2646 would lift the 16-bed limit for inpatient stays of 30 days or less.

Such a change would be “huge. It would definitely increase access to services,” Dr. Norris said in an interview. The bill also calls for the elimination of the 190-day lifetime cap on inpatient psychiatric care covered by Medicare.

The overall aim of the bill, according to Rep. Murphy, is to reinforce existing mental health parity laws and to create more integrated evidence-based interventions for mental disorders, especially serious mental illnesses such as schizophrenia or bipolar disorder. The bill would implement primary care– and community health center–based schizophrenia screening and treatment protocols derived from two projects sponsored by the National Institute of Mental Health: the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After Initial Schizophrenia Episode (RAISE) project.

The bill would increase and consolidate federal oversight of mental health care by doing away with the current top job at the Substance Abuse and Mental Health Services Administration and creating an assistant secretary appointed by the Senate to oversee mental health and substance abuse treatment within the Health and Human Services department. Further, the bill stipulates that the position must be held by a psychiatrist or psychologist. The assistant secretary would administer the current SAMHSA. “I don’t want to eliminate SAMHSA, I want to elevate it,” Rep. Murphy said in an interview.

Several key provisions of the bill have been modified since it was introduced in the last Congress. Previously, Rep. Murphy called for eliminating funds for patients-rights groups, saying they were aligned with the “antipsychiatry movement” that would go as far as advocating people with severe mental illness not take their prescribed medications. Instead, H.R. 2646 would restrict funds to groups that investigate patient abuse and neglect only, which Rep. Murphy said would prevent antipsychiatry activists and others from giving dangerous counsel to those who lack insight into their condition.

The new bill has bipartisan support among subcommittee members. “It’s different than we saw last Congress,” Lauren Alfred, policy director for the Kennedy Forum, said in an interview. “Last time it was more about reacting to crisis, this time it’s more about the future. The focus is on what will happen in primary care offices and across the system if comprehensive mental health care reform goes forward.”

Despite that support, there is some dissent.

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy & Commerce Committee, testified that he favors the language on workforce development and parity enforcement but is opposed to predicating community mental health block grant funding on the existence of state treatment standard and assisted outpatient treatment laws, which Rep. Murphy’s proposed legislation would do.

The bill also raised some alarm with references to antiabortion language. Subcommittee member Rep. Jan Schakowsky (D-Ill.) noted that H.R. 2646 would expand existing restrictions on the use of grant funds to pay for abortions by reauthorizing the Garrett Lee Smith Memorial Act, a suicide prevention law. Rep. Murphy dismissed this claim in an interview, noting that to remove the antiabortion language would mean rewriting the existing suicide prevention law. “It’s existing law from a decade ago and we simply reference that whole bill,” he said. “We haven’t changed anything. There’s nothing partisan or sneaky about it.”

[email protected]

On Twitter @whitneymcknight

*Correction, 6/22/2015: An earlier version of this article misstated Dr. Jeffrey Lieberman's name.

WASHINGTON – A new bill sponsored by Rep. Tim Murphy (R-Pa.) aims to improve the treatment of serious mental illness by providing access and assistance to families and caregivers, improving mental health and substance abuse treatment parity, and encouraging evidence-based mental health care.

H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, also would increase the number of psychiatric hospital beds for those in acute crisis, allocate funds to mental and behavioral health workforce development, and reform oversight of mental health care delivery.

The bill was originally introduced in the last Congress, after the mass shooting in Newtown, Conn. It is based on the findings of a report commissioned by the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations, which cited high levels of untreated serious mental illness nationwide.

During a June 16 hearing on the bill, Virginia state senator Creigh Deeds, a Democrat, testified about his son’s serious mental illness. Sen. Deeds said that it wasn’t until after his son had stabbed him multiple times, then killed himself, that the senator learned the details of his son’s treatment for bipolar disorder. Those details might have allowed him to successfully intervene and save his son, Sen. Deeds said. The information he did get often came anonymously, he added, due to providers’ fears of violating HIPAA (Health Insurance Portability and Accountability Act).

“HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. Even though I was the one who cared for him, fed him, housed him, transported him, insured him, I was not privy to any information that could clarify for me his behaviors, his treatment plan, and symptoms to be vigilant about,” Sen. Deeds testified. “I was in the dark as I tried to advocate for him in the best way I could with the best information I had.”

H.R. 2646 would amend HIPAA and FERPA (Family Educational Rights and Privacy Act) to allow family members and other caregivers access to diagnoses, treatment plans, and prescribed medications without patient consent. Release of psychotherapy notes would remain prohibited, however.

Meanwhile, patient privacy legislation (H.R. 2690) introduced by Rep. Doris Matsui (D-Calif.) and considered during the same hearing would clarify and strengthen existing language in HIPAA law by amending but not rewriting it. H.R. 2690 would de-escalate the fears of medical personnel surrounding HIPAA, which Rep. Matsui said was appropriately written but not always applied as intended.

Dr. Jeffrey Lieberman*, chair of the psychiatry department at Columbia University, New York, testified that “simply educating doctors” would not be enough to impact how HIPAA-protected information was shared with concerned families because of “the fear of God placed in doctors by personal injury lawyers who often challenge doctors” even when doctors are doing “the common-sense thing to do.”

H.R. 2646 also calls for medical records and mental health records to be integrated. “If a primary care physician doesn’t know that a patient is recovering from an opiate addiction, that provider might misprescribe the patient an opiate and start that patient into a relapse,” Rep. Murphy said in an interview. “Instead of making the files separate but equal, you make them the same. You can’t treat the brain without treating the body.”

The bill also would change the way Medicaid pays for acute care psychiatric services. Currently, under the institutions of mental disease exclusion, federal Medicaid funds can be used for no more than 16 beds in an inpatient psychiatric facility. According to Dr. Lorenzo Norris, director of inpatient psychiatric services at George Washington University Hospital, Washington, D.C., the result is that state-funded facilities often turn away patients experiencing acute mental health crises. H.R. 2646 would lift the 16-bed limit for inpatient stays of 30 days or less.

Such a change would be “huge. It would definitely increase access to services,” Dr. Norris said in an interview. The bill also calls for the elimination of the 190-day lifetime cap on inpatient psychiatric care covered by Medicare.

The overall aim of the bill, according to Rep. Murphy, is to reinforce existing mental health parity laws and to create more integrated evidence-based interventions for mental disorders, especially serious mental illnesses such as schizophrenia or bipolar disorder. The bill would implement primary care– and community health center–based schizophrenia screening and treatment protocols derived from two projects sponsored by the National Institute of Mental Health: the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After Initial Schizophrenia Episode (RAISE) project.

The bill would increase and consolidate federal oversight of mental health care by doing away with the current top job at the Substance Abuse and Mental Health Services Administration and creating an assistant secretary appointed by the Senate to oversee mental health and substance abuse treatment within the Health and Human Services department. Further, the bill stipulates that the position must be held by a psychiatrist or psychologist. The assistant secretary would administer the current SAMHSA. “I don’t want to eliminate SAMHSA, I want to elevate it,” Rep. Murphy said in an interview.

Several key provisions of the bill have been modified since it was introduced in the last Congress. Previously, Rep. Murphy called for eliminating funds for patients-rights groups, saying they were aligned with the “antipsychiatry movement” that would go as far as advocating people with severe mental illness not take their prescribed medications. Instead, H.R. 2646 would restrict funds to groups that investigate patient abuse and neglect only, which Rep. Murphy said would prevent antipsychiatry activists and others from giving dangerous counsel to those who lack insight into their condition.

The new bill has bipartisan support among subcommittee members. “It’s different than we saw last Congress,” Lauren Alfred, policy director for the Kennedy Forum, said in an interview. “Last time it was more about reacting to crisis, this time it’s more about the future. The focus is on what will happen in primary care offices and across the system if comprehensive mental health care reform goes forward.”

Despite that support, there is some dissent.

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy & Commerce Committee, testified that he favors the language on workforce development and parity enforcement but is opposed to predicating community mental health block grant funding on the existence of state treatment standard and assisted outpatient treatment laws, which Rep. Murphy’s proposed legislation would do.

The bill also raised some alarm with references to antiabortion language. Subcommittee member Rep. Jan Schakowsky (D-Ill.) noted that H.R. 2646 would expand existing restrictions on the use of grant funds to pay for abortions by reauthorizing the Garrett Lee Smith Memorial Act, a suicide prevention law. Rep. Murphy dismissed this claim in an interview, noting that to remove the antiabortion language would mean rewriting the existing suicide prevention law. “It’s existing law from a decade ago and we simply reference that whole bill,” he said. “We haven’t changed anything. There’s nothing partisan or sneaky about it.”

[email protected]

On Twitter @whitneymcknight

*Correction, 6/22/2015: An earlier version of this article misstated Dr. Jeffrey Lieberman's name.

WASHINGTON – A new bill sponsored by Rep. Tim Murphy (R-Pa.) aims to improve the treatment of serious mental illness by providing access and assistance to families and caregivers, improving mental health and substance abuse treatment parity, and encouraging evidence-based mental health care.

H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, also would increase the number of psychiatric hospital beds for those in acute crisis, allocate funds to mental and behavioral health workforce development, and reform oversight of mental health care delivery.

The bill was originally introduced in the last Congress, after the mass shooting in Newtown, Conn. It is based on the findings of a report commissioned by the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations, which cited high levels of untreated serious mental illness nationwide.

During a June 16 hearing on the bill, Virginia state senator Creigh Deeds, a Democrat, testified about his son’s serious mental illness. Sen. Deeds said that it wasn’t until after his son had stabbed him multiple times, then killed himself, that the senator learned the details of his son’s treatment for bipolar disorder. Those details might have allowed him to successfully intervene and save his son, Sen. Deeds said. The information he did get often came anonymously, he added, due to providers’ fears of violating HIPAA (Health Insurance Portability and Accountability Act).

“HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. Even though I was the one who cared for him, fed him, housed him, transported him, insured him, I was not privy to any information that could clarify for me his behaviors, his treatment plan, and symptoms to be vigilant about,” Sen. Deeds testified. “I was in the dark as I tried to advocate for him in the best way I could with the best information I had.”

H.R. 2646 would amend HIPAA and FERPA (Family Educational Rights and Privacy Act) to allow family members and other caregivers access to diagnoses, treatment plans, and prescribed medications without patient consent. Release of psychotherapy notes would remain prohibited, however.

Meanwhile, patient privacy legislation (H.R. 2690) introduced by Rep. Doris Matsui (D-Calif.) and considered during the same hearing would clarify and strengthen existing language in HIPAA law by amending but not rewriting it. H.R. 2690 would de-escalate the fears of medical personnel surrounding HIPAA, which Rep. Matsui said was appropriately written but not always applied as intended.

Dr. Jeffrey Lieberman*, chair of the psychiatry department at Columbia University, New York, testified that “simply educating doctors” would not be enough to impact how HIPAA-protected information was shared with concerned families because of “the fear of God placed in doctors by personal injury lawyers who often challenge doctors” even when doctors are doing “the common-sense thing to do.”

H.R. 2646 also calls for medical records and mental health records to be integrated. “If a primary care physician doesn’t know that a patient is recovering from an opiate addiction, that provider might misprescribe the patient an opiate and start that patient into a relapse,” Rep. Murphy said in an interview. “Instead of making the files separate but equal, you make them the same. You can’t treat the brain without treating the body.”

The bill also would change the way Medicaid pays for acute care psychiatric services. Currently, under the institutions of mental disease exclusion, federal Medicaid funds can be used for no more than 16 beds in an inpatient psychiatric facility. According to Dr. Lorenzo Norris, director of inpatient psychiatric services at George Washington University Hospital, Washington, D.C., the result is that state-funded facilities often turn away patients experiencing acute mental health crises. H.R. 2646 would lift the 16-bed limit for inpatient stays of 30 days or less.

Such a change would be “huge. It would definitely increase access to services,” Dr. Norris said in an interview. The bill also calls for the elimination of the 190-day lifetime cap on inpatient psychiatric care covered by Medicare.

The overall aim of the bill, according to Rep. Murphy, is to reinforce existing mental health parity laws and to create more integrated evidence-based interventions for mental disorders, especially serious mental illnesses such as schizophrenia or bipolar disorder. The bill would implement primary care– and community health center–based schizophrenia screening and treatment protocols derived from two projects sponsored by the National Institute of Mental Health: the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After Initial Schizophrenia Episode (RAISE) project.

The bill would increase and consolidate federal oversight of mental health care by doing away with the current top job at the Substance Abuse and Mental Health Services Administration and creating an assistant secretary appointed by the Senate to oversee mental health and substance abuse treatment within the Health and Human Services department. Further, the bill stipulates that the position must be held by a psychiatrist or psychologist. The assistant secretary would administer the current SAMHSA. “I don’t want to eliminate SAMHSA, I want to elevate it,” Rep. Murphy said in an interview.

Several key provisions of the bill have been modified since it was introduced in the last Congress. Previously, Rep. Murphy called for eliminating funds for patients-rights groups, saying they were aligned with the “antipsychiatry movement” that would go as far as advocating people with severe mental illness not take their prescribed medications. Instead, H.R. 2646 would restrict funds to groups that investigate patient abuse and neglect only, which Rep. Murphy said would prevent antipsychiatry activists and others from giving dangerous counsel to those who lack insight into their condition.

The new bill has bipartisan support among subcommittee members. “It’s different than we saw last Congress,” Lauren Alfred, policy director for the Kennedy Forum, said in an interview. “Last time it was more about reacting to crisis, this time it’s more about the future. The focus is on what will happen in primary care offices and across the system if comprehensive mental health care reform goes forward.”

Despite that support, there is some dissent.

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy & Commerce Committee, testified that he favors the language on workforce development and parity enforcement but is opposed to predicating community mental health block grant funding on the existence of state treatment standard and assisted outpatient treatment laws, which Rep. Murphy’s proposed legislation would do.

The bill also raised some alarm with references to antiabortion language. Subcommittee member Rep. Jan Schakowsky (D-Ill.) noted that H.R. 2646 would expand existing restrictions on the use of grant funds to pay for abortions by reauthorizing the Garrett Lee Smith Memorial Act, a suicide prevention law. Rep. Murphy dismissed this claim in an interview, noting that to remove the antiabortion language would mean rewriting the existing suicide prevention law. “It’s existing law from a decade ago and we simply reference that whole bill,” he said. “We haven’t changed anything. There’s nothing partisan or sneaky about it.”

[email protected]

On Twitter @whitneymcknight

*Correction, 6/22/2015: An earlier version of this article misstated Dr. Jeffrey Lieberman's name.

About one-third of people with bipolar disorder are affected by comorbid migraine, and migraine is significantly more common among bipolar II disorder patients than among those with bipolar I disorder, a meta-analysis shows.

The meta-analysis covered 14 studies of 3,976 patients with some type of bipolar disorder from North America, Europe, and South America. Of the sample, 2,161 had bipolar I disorder and 647 had bipolar II disorder. The type of bipolar disorder the other patients had was either mixed or unknown. On average, each of the studies included 283.69 participants, and the mean age of a participant was 35.5 years. Studies that reported the prevalence of bipolar disorder among people with migraines were excluded.

Fifty-four percent of bipolar II disorder patients had migraines, compared with 32.7% of bipolar I disorder patients. An additional finding of the meta-analysis is that migraine was found significantly more often in studies that used standardized criteria to determine whether a bipolar patient had comorbid migraine than in studies that used nonstandardized criteria, such as self-report.

A meta-regression analysis of data from the studies showed that mean age moderated how frequently migraine occurred among the entire sample.

“The findings of this meta-analysis suggest that the prevalence of comorbid migraine among people with [bipolar disorder] is remarkably high, particularly among people with [bipolar II disorder],” according to Dr. Michele Fornaro and Brendon Stubbs.

The results of this meta-analysis “highlighted the need for further studies focusing on [migraine-bipolar II disorder] comobidity including well-matched control cases with or without rapid cycling features too,” according to the researchers.

Read the full study in Journal of Affective Disorders (doi:http://dx.doi.org/10.1016/j.jad.2015.02.032).

[email protected]

About one-third of people with bipolar disorder are affected by comorbid migraine, and migraine is significantly more common among bipolar II disorder patients than among those with bipolar I disorder, a meta-analysis shows.

The meta-analysis covered 14 studies of 3,976 patients with some type of bipolar disorder from North America, Europe, and South America. Of the sample, 2,161 had bipolar I disorder and 647 had bipolar II disorder. The type of bipolar disorder the other patients had was either mixed or unknown. On average, each of the studies included 283.69 participants, and the mean age of a participant was 35.5 years. Studies that reported the prevalence of bipolar disorder among people with migraines were excluded.

Fifty-four percent of bipolar II disorder patients had migraines, compared with 32.7% of bipolar I disorder patients. An additional finding of the meta-analysis is that migraine was found significantly more often in studies that used standardized criteria to determine whether a bipolar patient had comorbid migraine than in studies that used nonstandardized criteria, such as self-report.

A meta-regression analysis of data from the studies showed that mean age moderated how frequently migraine occurred among the entire sample.

“The findings of this meta-analysis suggest that the prevalence of comorbid migraine among people with [bipolar disorder] is remarkably high, particularly among people with [bipolar II disorder],” according to Dr. Michele Fornaro and Brendon Stubbs.

The results of this meta-analysis “highlighted the need for further studies focusing on [migraine-bipolar II disorder] comobidity including well-matched control cases with or without rapid cycling features too,” according to the researchers.

Read the full study in Journal of Affective Disorders (doi:http://dx.doi.org/10.1016/j.jad.2015.02.032).

[email protected]

About one-third of people with bipolar disorder are affected by comorbid migraine, and migraine is significantly more common among bipolar II disorder patients than among those with bipolar I disorder, a meta-analysis shows.

The meta-analysis covered 14 studies of 3,976 patients with some type of bipolar disorder from North America, Europe, and South America. Of the sample, 2,161 had bipolar I disorder and 647 had bipolar II disorder. The type of bipolar disorder the other patients had was either mixed or unknown. On average, each of the studies included 283.69 participants, and the mean age of a participant was 35.5 years. Studies that reported the prevalence of bipolar disorder among people with migraines were excluded.

Fifty-four percent of bipolar II disorder patients had migraines, compared with 32.7% of bipolar I disorder patients. An additional finding of the meta-analysis is that migraine was found significantly more often in studies that used standardized criteria to determine whether a bipolar patient had comorbid migraine than in studies that used nonstandardized criteria, such as self-report.

A meta-regression analysis of data from the studies showed that mean age moderated how frequently migraine occurred among the entire sample.

“The findings of this meta-analysis suggest that the prevalence of comorbid migraine among people with [bipolar disorder] is remarkably high, particularly among people with [bipolar II disorder],” according to Dr. Michele Fornaro and Brendon Stubbs.

The results of this meta-analysis “highlighted the need for further studies focusing on [migraine-bipolar II disorder] comobidity including well-matched control cases with or without rapid cycling features too,” according to the researchers.

Read the full study in Journal of Affective Disorders (doi:http://dx.doi.org/10.1016/j.jad.2015.02.032).

[email protected]

Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders (doi:10.1016/j.jd2015.04.024).

[email protected]

Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders (doi:10.1016/j.jd2015.04.024).

[email protected]

Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders (doi:10.1016/j.jd2015.04.024).

[email protected]

Creativity is linked to ambition in patients with bipolar disorder, according to study results published in the Journal of Affective Disorders.

Sheri L. Johnson, Ph.D., and her colleagues in the department of psychology at the University of California, Berkeley, performed two studies: The first assessed accomplishment in 22 patients with bipolar disorder who self-identified as highly creative; the second study examined creative accomplishment and mania risk in 221 undergraduates.

The results from the first study showed that WASSUP scores, a measure of mania risk, were higher in highly creative bipolar patients (27.45) than in normative bipolar patients (14.10) and patients with no mood disorder (9.06). The second study found that mania risk and ambition were both linked to greater creativity, the authors reported.

“Findings across two studies strongly suggest that across the bipolar spectrum, ambition and creativity are linked,” Dr. Johnson and her associates wrote.

Read the full article in the Journal of Affective Disorders.

Creativity is linked to ambition in patients with bipolar disorder, according to study results published in the Journal of Affective Disorders.

Sheri L. Johnson, Ph.D., and her colleagues in the department of psychology at the University of California, Berkeley, performed two studies: The first assessed accomplishment in 22 patients with bipolar disorder who self-identified as highly creative; the second study examined creative accomplishment and mania risk in 221 undergraduates.

The results from the first study showed that WASSUP scores, a measure of mania risk, were higher in highly creative bipolar patients (27.45) than in normative bipolar patients (14.10) and patients with no mood disorder (9.06). The second study found that mania risk and ambition were both linked to greater creativity, the authors reported.

“Findings across two studies strongly suggest that across the bipolar spectrum, ambition and creativity are linked,” Dr. Johnson and her associates wrote.

Read the full article in the Journal of Affective Disorders.

Creativity is linked to ambition in patients with bipolar disorder, according to study results published in the Journal of Affective Disorders.

Sheri L. Johnson, Ph.D., and her colleagues in the department of psychology at the University of California, Berkeley, performed two studies: The first assessed accomplishment in 22 patients with bipolar disorder who self-identified as highly creative; the second study examined creative accomplishment and mania risk in 221 undergraduates.

The results from the first study showed that WASSUP scores, a measure of mania risk, were higher in highly creative bipolar patients (27.45) than in normative bipolar patients (14.10) and patients with no mood disorder (9.06). The second study found that mania risk and ambition were both linked to greater creativity, the authors reported.

“Findings across two studies strongly suggest that across the bipolar spectrum, ambition and creativity are linked,” Dr. Johnson and her associates wrote.

Read the full article in the Journal of Affective Disorders.

New research into bipolar I disorder (BPI) suggests the existence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features that differ from standard bipolar, according to a study published in the Journal of Affective Disorders.

Shanker Swaminathan, Ph.D., of Indiana University, Indianapolis, and his associates analyzed a cohort of 2,505 patients with bipolar I, taken from the National Institute of Mental Health (NIMH) Bipolar Disorder Genetics Initiative over 18 years and split into nonexternalizing and externalizing groups.

They noticed increased severity and frequency of mood disorder symptoms and episodes in the externalizing group, particularly in the early-onset externalizing subgroup. For example, nonsuicidal self-harm was seen in 30.2% of early-onset subjects, compared to 10% of nonexternalizing subjects (and 26% of externalizing subjects as a whole). Rapid switching was seen in 70.6% of early-onset subjects, compared to 48.6% of nonexternalizing subjects (and 62.8% of externalizing subjects as a whole), reported Dr. Swaminathan.

“In every parameter tested, subjects with externalizing disorders show evidence of greater symptomatology, earlier onset, and more impairment. This is true even when care is taken to exclude the direct effects of substances,” the authors wrote.

Read the full article here.

New research into bipolar I disorder (BPI) suggests the existence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features that differ from standard bipolar, according to a study published in the Journal of Affective Disorders.

Shanker Swaminathan, Ph.D., of Indiana University, Indianapolis, and his associates analyzed a cohort of 2,505 patients with bipolar I, taken from the National Institute of Mental Health (NIMH) Bipolar Disorder Genetics Initiative over 18 years and split into nonexternalizing and externalizing groups.

They noticed increased severity and frequency of mood disorder symptoms and episodes in the externalizing group, particularly in the early-onset externalizing subgroup. For example, nonsuicidal self-harm was seen in 30.2% of early-onset subjects, compared to 10% of nonexternalizing subjects (and 26% of externalizing subjects as a whole). Rapid switching was seen in 70.6% of early-onset subjects, compared to 48.6% of nonexternalizing subjects (and 62.8% of externalizing subjects as a whole), reported Dr. Swaminathan.

“In every parameter tested, subjects with externalizing disorders show evidence of greater symptomatology, earlier onset, and more impairment. This is true even when care is taken to exclude the direct effects of substances,” the authors wrote.

Read the full article here.

New research into bipolar I disorder (BPI) suggests the existence of an externalizing disorder subphenotype within BPI with greater severity of mood disorder and possible specific genetic features that differ from standard bipolar, according to a study published in the Journal of Affective Disorders.

Shanker Swaminathan, Ph.D., of Indiana University, Indianapolis, and his associates analyzed a cohort of 2,505 patients with bipolar I, taken from the National Institute of Mental Health (NIMH) Bipolar Disorder Genetics Initiative over 18 years and split into nonexternalizing and externalizing groups.

They noticed increased severity and frequency of mood disorder symptoms and episodes in the externalizing group, particularly in the early-onset externalizing subgroup. For example, nonsuicidal self-harm was seen in 30.2% of early-onset subjects, compared to 10% of nonexternalizing subjects (and 26% of externalizing subjects as a whole). Rapid switching was seen in 70.6% of early-onset subjects, compared to 48.6% of nonexternalizing subjects (and 62.8% of externalizing subjects as a whole), reported Dr. Swaminathan.

“In every parameter tested, subjects with externalizing disorders show evidence of greater symptomatology, earlier onset, and more impairment. This is true even when care is taken to exclude the direct effects of substances,” the authors wrote.

Read the full article here.

In a small study, five themes were identified with regard to creativity and how it is influenced by bipolar disorder, according to Sheri L. Johnson, Ph.D., and her associates.

Study participants took three tests: the Seven-up Seven-down scale, the Brief Quality of Life in Bipolar Disorder scale, and the Creative Achievement Questionnaire. After qualitative analysis, several themes emerged: the pros and cons of manic energy, benefits of altered thinking, finding a balance of medication that promotes creativity, the idea of creativity as central to the identity of a person with BD, and the importance of creativity in reducing stigma and improving treatment.

“Participants were eager to see their creativity taken into account within treatment as a way to help foster more positive communication and to combat the stigma that they all too often experience. As such, creativity appears to be a positive focus for promoting growth and wellness, and for reducing stigma,” the investigators said.

Find the full study in Qualitative Health Research (doi: 10.1177/1049732315578403).

[email protected]

In a small study, five themes were identified with regard to creativity and how it is influenced by bipolar disorder, according to Sheri L. Johnson, Ph.D., and her associates.

Study participants took three tests: the Seven-up Seven-down scale, the Brief Quality of Life in Bipolar Disorder scale, and the Creative Achievement Questionnaire. After qualitative analysis, several themes emerged: the pros and cons of manic energy, benefits of altered thinking, finding a balance of medication that promotes creativity, the idea of creativity as central to the identity of a person with BD, and the importance of creativity in reducing stigma and improving treatment.

“Participants were eager to see their creativity taken into account within treatment as a way to help foster more positive communication and to combat the stigma that they all too often experience. As such, creativity appears to be a positive focus for promoting growth and wellness, and for reducing stigma,” the investigators said.

Find the full study in Qualitative Health Research (doi: 10.1177/1049732315578403).

[email protected]

In a small study, five themes were identified with regard to creativity and how it is influenced by bipolar disorder, according to Sheri L. Johnson, Ph.D., and her associates.

Study participants took three tests: the Seven-up Seven-down scale, the Brief Quality of Life in Bipolar Disorder scale, and the Creative Achievement Questionnaire. After qualitative analysis, several themes emerged: the pros and cons of manic energy, benefits of altered thinking, finding a balance of medication that promotes creativity, the idea of creativity as central to the identity of a person with BD, and the importance of creativity in reducing stigma and improving treatment.

“Participants were eager to see their creativity taken into account within treatment as a way to help foster more positive communication and to combat the stigma that they all too often experience. As such, creativity appears to be a positive focus for promoting growth and wellness, and for reducing stigma,” the investigators said.

Find the full study in Qualitative Health Research (doi: 10.1177/1049732315578403).

[email protected]