Bipolar Disorder

Group cognitive-behavioral therapy, often recommended as first-line therapy for social anxiety disorder, is effective even when patients have comorbid major depressive or anxiety disorders, a recent report shows.

Few previous studies have examined whether coexisting depression or anxiety influence the outcome of psychological treatment for social anxiety, and their findings have been conflicting. In this study, researchers assessed pre- and posttreatment results on the Social Phobia Inventory and the Depression Anxiety Stress Scales for 163 adults treated with group CBT at a single community hospital outpatient clinic over a 10-year period. Forty-one of these participants had social anxiety disorder with no comorbid diagnoses, 76 had comorbid major depressive disorder, 19 had comorbid bipolar disorder, and 27 had additional comorbid anxiety disorders.

The average age of onset of social anxiety disorder was 12 years in the 77 men and 86 women. A total of 85% were white, said Katie Fracalanza, a doctoral student in the department of psychology, Ryerson University, Toronto, and her associates.

All patients showed significant improvement in social anxiety symptoms after treatment, regardless of their comorbidities. Also, small to moderate improvements were found in depressive symptoms, the investigators reported (J. Affect. Disord. 2014;162:61-6).

Patients with comorbid disorders presented with more severe symptoms than did those who only had social anxiety disorder, and they completed treatment with greater residual symptoms, though still significantly improved. Additional sessions might be helpful for further symptom remission in such patients, Ms. Fracalanza and her associates said.

Limitations of the study include the self-report nature of social anxiety and depressive symptoms, and the relatively small sample size. Nevertheless, these findings are in line with those of previous studies reporting that depressive symptoms "do not hinder the effectiveness of CBT for social anxiety disorder" and might improve even though they are not specifically targeted by the treatment, the investigators noted.

Group cognitive-behavioral therapy, often recommended as first-line therapy for social anxiety disorder, is effective even when patients have comorbid major depressive or anxiety disorders, a recent report shows.

Few previous studies have examined whether coexisting depression or anxiety influence the outcome of psychological treatment for social anxiety, and their findings have been conflicting. In this study, researchers assessed pre- and posttreatment results on the Social Phobia Inventory and the Depression Anxiety Stress Scales for 163 adults treated with group CBT at a single community hospital outpatient clinic over a 10-year period. Forty-one of these participants had social anxiety disorder with no comorbid diagnoses, 76 had comorbid major depressive disorder, 19 had comorbid bipolar disorder, and 27 had additional comorbid anxiety disorders.

The average age of onset of social anxiety disorder was 12 years in the 77 men and 86 women. A total of 85% were white, said Katie Fracalanza, a doctoral student in the department of psychology, Ryerson University, Toronto, and her associates.

All patients showed significant improvement in social anxiety symptoms after treatment, regardless of their comorbidities. Also, small to moderate improvements were found in depressive symptoms, the investigators reported (J. Affect. Disord. 2014;162:61-6).

Patients with comorbid disorders presented with more severe symptoms than did those who only had social anxiety disorder, and they completed treatment with greater residual symptoms, though still significantly improved. Additional sessions might be helpful for further symptom remission in such patients, Ms. Fracalanza and her associates said.

Limitations of the study include the self-report nature of social anxiety and depressive symptoms, and the relatively small sample size. Nevertheless, these findings are in line with those of previous studies reporting that depressive symptoms "do not hinder the effectiveness of CBT for social anxiety disorder" and might improve even though they are not specifically targeted by the treatment, the investigators noted.

Group cognitive-behavioral therapy, often recommended as first-line therapy for social anxiety disorder, is effective even when patients have comorbid major depressive or anxiety disorders, a recent report shows.

Few previous studies have examined whether coexisting depression or anxiety influence the outcome of psychological treatment for social anxiety, and their findings have been conflicting. In this study, researchers assessed pre- and posttreatment results on the Social Phobia Inventory and the Depression Anxiety Stress Scales for 163 adults treated with group CBT at a single community hospital outpatient clinic over a 10-year period. Forty-one of these participants had social anxiety disorder with no comorbid diagnoses, 76 had comorbid major depressive disorder, 19 had comorbid bipolar disorder, and 27 had additional comorbid anxiety disorders.

The average age of onset of social anxiety disorder was 12 years in the 77 men and 86 women. A total of 85% were white, said Katie Fracalanza, a doctoral student in the department of psychology, Ryerson University, Toronto, and her associates.

All patients showed significant improvement in social anxiety symptoms after treatment, regardless of their comorbidities. Also, small to moderate improvements were found in depressive symptoms, the investigators reported (J. Affect. Disord. 2014;162:61-6).

Patients with comorbid disorders presented with more severe symptoms than did those who only had social anxiety disorder, and they completed treatment with greater residual symptoms, though still significantly improved. Additional sessions might be helpful for further symptom remission in such patients, Ms. Fracalanza and her associates said.

Limitations of the study include the self-report nature of social anxiety and depressive symptoms, and the relatively small sample size. Nevertheless, these findings are in line with those of previous studies reporting that depressive symptoms "do not hinder the effectiveness of CBT for social anxiety disorder" and might improve even though they are not specifically targeted by the treatment, the investigators noted.

NEW YORK – The likelihood that patients with major mood disorders will attempt or complete suicide appears to be related to the amount of time they spend in high-risk states of illness, results of longitudinal studies suggest.

"Among mood disorder patients, in any setting, there is a very strong association between suicidal acts and mood state," said Dr. Erkki T. Isometsä, professor of psychiatry at the University of Helsinki.

"Time spent in high-risk illness states is a major determinant of overall risk. Thus, for prevention of suicidal acts, reducing time in high-risk illness states is essential," he said at the American Psychiatric Association annual meeting.

Neil Osterweil/Frontline Medical News

Providing effective acute therapies and maintenance-phase treatment and improving continuity of care has the potential to significantly decrease suicidal acts, Dr. Isometsä said.

He noted that half of all suicides are committed by people who suffer from major mood disorders such as depression and bipolar disorder. A recently published meta-analysis and systematic review found that factors significantly associated with suicide were male sex (odds ratio, 1.76); a family history of psychiatric disorder (OR, 1.41); previous suicide attempt (OR, 4.84); more severe depression (OR, 2.20); hopelessness (OR, 2.20); and comorbid disorders, including anxiety (OR, 1.59) and substance misuse (OR, 2.17) (J. Affect. Disord. 2013;147:17-28).

Dr. Isometsä pointed to an International Society for Bipolar Disorders (ISBD) task force on suicide, whose members identified risk variables associated with suicide attempts and suicide deaths.

Suicide attempts were more likely in patients with bipolar disorder who had depressive polarity of their first, current, or most recent illness episode; comorbid cluster/borderline personality disorder; any comorbid anxiety or substance use disorder; history of suicide in a first-degree relative; female sex; and younger age of illness at onset.

However, only suicide of a first-degree relative and male sex were significantly associated with suicide deaths.

Longitudinal studies

Dr. Isometsä was the lead investigator for two longitudinal studies of Finnish patients with mood disorders: the Vantaa Primary Care Depression Study and the Jorvi Bipolar Study. Both studies looked at the incidence of suicide attempts over time across variable mood states.

In the depression study, the investigators compared the incidence of suicide attempts among depressed patients during major depressive episodes, partial remissions, and full remissions over 5 years of follow-up and found that 78% of the attempts (adjusted population attributable fraction [PAF]) occurred during major depressive episodes.

Factors significantly associated with suicide attempts were a prior attempt (OR, 4.39), partial vs. full remission (OR, 4.20), and major depressive episode (OR, 7.74).

Protective factors included age (OR, 0.94), married or cohabiting (OR, 0.43), intermediate social support (OR, 0.36), and high social support (OR, 0.28).

In the Jorvi Bipolar Study, which looked at patients with both bipolar disorders I and II, the incidence was of suicide attempts was 37 times higher when patients were in combined mixed and depressive mixed states and 18-fold higher during major depressive phases, compared with other illness states. In this study, the PAF for time spent in high-risk illness phase was 86%.

In each study, suicidal acts during mood episodes also was more likely among patients who had hopelessness, a history of abuse in childhood, poor social support, concurrent substance use, cluster B personality disorders, and those with impulsive-aggressive traits.

But of all of the associated factors, time spent in high-risk phases of illness appeared to be the predominant, modifiable driver of suicidal acts, Dr. Isometsä concluded.

The Vantaa and Jorvi studies were supported by the National Institute for Health and Welfare, Finland. Dr. Isometsä reported having no conflicts of interest.

NEW YORK – The likelihood that patients with major mood disorders will attempt or complete suicide appears to be related to the amount of time they spend in high-risk states of illness, results of longitudinal studies suggest.

"Among mood disorder patients, in any setting, there is a very strong association between suicidal acts and mood state," said Dr. Erkki T. Isometsä, professor of psychiatry at the University of Helsinki.

"Time spent in high-risk illness states is a major determinant of overall risk. Thus, for prevention of suicidal acts, reducing time in high-risk illness states is essential," he said at the American Psychiatric Association annual meeting.

Neil Osterweil/Frontline Medical News

Providing effective acute therapies and maintenance-phase treatment and improving continuity of care has the potential to significantly decrease suicidal acts, Dr. Isometsä said.

He noted that half of all suicides are committed by people who suffer from major mood disorders such as depression and bipolar disorder. A recently published meta-analysis and systematic review found that factors significantly associated with suicide were male sex (odds ratio, 1.76); a family history of psychiatric disorder (OR, 1.41); previous suicide attempt (OR, 4.84); more severe depression (OR, 2.20); hopelessness (OR, 2.20); and comorbid disorders, including anxiety (OR, 1.59) and substance misuse (OR, 2.17) (J. Affect. Disord. 2013;147:17-28).

Dr. Isometsä pointed to an International Society for Bipolar Disorders (ISBD) task force on suicide, whose members identified risk variables associated with suicide attempts and suicide deaths.

Suicide attempts were more likely in patients with bipolar disorder who had depressive polarity of their first, current, or most recent illness episode; comorbid cluster/borderline personality disorder; any comorbid anxiety or substance use disorder; history of suicide in a first-degree relative; female sex; and younger age of illness at onset.

However, only suicide of a first-degree relative and male sex were significantly associated with suicide deaths.

Longitudinal studies

Dr. Isometsä was the lead investigator for two longitudinal studies of Finnish patients with mood disorders: the Vantaa Primary Care Depression Study and the Jorvi Bipolar Study. Both studies looked at the incidence of suicide attempts over time across variable mood states.

In the depression study, the investigators compared the incidence of suicide attempts among depressed patients during major depressive episodes, partial remissions, and full remissions over 5 years of follow-up and found that 78% of the attempts (adjusted population attributable fraction [PAF]) occurred during major depressive episodes.

Factors significantly associated with suicide attempts were a prior attempt (OR, 4.39), partial vs. full remission (OR, 4.20), and major depressive episode (OR, 7.74).

Protective factors included age (OR, 0.94), married or cohabiting (OR, 0.43), intermediate social support (OR, 0.36), and high social support (OR, 0.28).

In the Jorvi Bipolar Study, which looked at patients with both bipolar disorders I and II, the incidence was of suicide attempts was 37 times higher when patients were in combined mixed and depressive mixed states and 18-fold higher during major depressive phases, compared with other illness states. In this study, the PAF for time spent in high-risk illness phase was 86%.

In each study, suicidal acts during mood episodes also was more likely among patients who had hopelessness, a history of abuse in childhood, poor social support, concurrent substance use, cluster B personality disorders, and those with impulsive-aggressive traits.

But of all of the associated factors, time spent in high-risk phases of illness appeared to be the predominant, modifiable driver of suicidal acts, Dr. Isometsä concluded.

The Vantaa and Jorvi studies were supported by the National Institute for Health and Welfare, Finland. Dr. Isometsä reported having no conflicts of interest.

NEW YORK – The likelihood that patients with major mood disorders will attempt or complete suicide appears to be related to the amount of time they spend in high-risk states of illness, results of longitudinal studies suggest.

"Among mood disorder patients, in any setting, there is a very strong association between suicidal acts and mood state," said Dr. Erkki T. Isometsä, professor of psychiatry at the University of Helsinki.

"Time spent in high-risk illness states is a major determinant of overall risk. Thus, for prevention of suicidal acts, reducing time in high-risk illness states is essential," he said at the American Psychiatric Association annual meeting.

Neil Osterweil/Frontline Medical News

Providing effective acute therapies and maintenance-phase treatment and improving continuity of care has the potential to significantly decrease suicidal acts, Dr. Isometsä said.

He noted that half of all suicides are committed by people who suffer from major mood disorders such as depression and bipolar disorder. A recently published meta-analysis and systematic review found that factors significantly associated with suicide were male sex (odds ratio, 1.76); a family history of psychiatric disorder (OR, 1.41); previous suicide attempt (OR, 4.84); more severe depression (OR, 2.20); hopelessness (OR, 2.20); and comorbid disorders, including anxiety (OR, 1.59) and substance misuse (OR, 2.17) (J. Affect. Disord. 2013;147:17-28).

Dr. Isometsä pointed to an International Society for Bipolar Disorders (ISBD) task force on suicide, whose members identified risk variables associated with suicide attempts and suicide deaths.

Suicide attempts were more likely in patients with bipolar disorder who had depressive polarity of their first, current, or most recent illness episode; comorbid cluster/borderline personality disorder; any comorbid anxiety or substance use disorder; history of suicide in a first-degree relative; female sex; and younger age of illness at onset.

However, only suicide of a first-degree relative and male sex were significantly associated with suicide deaths.

Longitudinal studies

Dr. Isometsä was the lead investigator for two longitudinal studies of Finnish patients with mood disorders: the Vantaa Primary Care Depression Study and the Jorvi Bipolar Study. Both studies looked at the incidence of suicide attempts over time across variable mood states.

In the depression study, the investigators compared the incidence of suicide attempts among depressed patients during major depressive episodes, partial remissions, and full remissions over 5 years of follow-up and found that 78% of the attempts (adjusted population attributable fraction [PAF]) occurred during major depressive episodes.

Factors significantly associated with suicide attempts were a prior attempt (OR, 4.39), partial vs. full remission (OR, 4.20), and major depressive episode (OR, 7.74).

Protective factors included age (OR, 0.94), married or cohabiting (OR, 0.43), intermediate social support (OR, 0.36), and high social support (OR, 0.28).

In the Jorvi Bipolar Study, which looked at patients with both bipolar disorders I and II, the incidence was of suicide attempts was 37 times higher when patients were in combined mixed and depressive mixed states and 18-fold higher during major depressive phases, compared with other illness states. In this study, the PAF for time spent in high-risk illness phase was 86%.

In each study, suicidal acts during mood episodes also was more likely among patients who had hopelessness, a history of abuse in childhood, poor social support, concurrent substance use, cluster B personality disorders, and those with impulsive-aggressive traits.

But of all of the associated factors, time spent in high-risk phases of illness appeared to be the predominant, modifiable driver of suicidal acts, Dr. Isometsä concluded.

The Vantaa and Jorvi studies were supported by the National Institute for Health and Welfare, Finland. Dr. Isometsä reported having no conflicts of interest.

NEW YORK – The safe, cheap, readily available medication N-acetylcysteine may be effective against difficult-to-treat compulsive grooming disorders, a trans-Atlantic study showed.

In a case series of six patients treated for trichotillomania (hair pulling) and/or skin excoriation (skin-picking disorder, or SPD) as comorbidities to an impulse control or affective disorder, treatment with N-acetylcysteine (NAC) 1,200-1,800 mg/day resulted in either complete abstinence or great improvement in self-damaging habits, said Dr. Gustavo Jesus of the Central Psychiatric Hospital of Lisbon.

Most cases show very good results of the use of NAC in difficult-to-treat grooming disorders, he said at the American Psychiatric Association annual meeting.

Although support for the use of NAC in grooming disorders comes largely from case reports, the available evidence supports his team’s findings, he added.

Neil Osterweil/Frontline Medical News

NAC is a precursor to cysteine, an amino acid that protects cells from oxidative stress, interacts with inflammatory mediators, and is a modulator of the glutaminergic system of neurotransmission.

The medication historically has been used to counteract acetaminophen overdose, as a mucolytic agent for the treatment of respiratory diseases, and in the treatment of contrast-induced nephropathy, polycystic ovary syndrome, and more recently, psychiatric disorders, because of its antioxidative and anti-inflammatory properties.

The agent has been studied most in schizophrenia, Dr. Jesus said, but has also been investigated in bipolar and depressive disorders, substance use problems, obsessive-compulsive disorders and impulse control disorders, including grooming disorders.

Few options

Dr. Jesus’s team, with colleagues in São Paulo, Brazil, reviewed the literature for drug treatment of trichotillomania, and found varying evidence for the use of clomipramine, desipramine, fluoxetine, olanzapine, naltrexone, and citalopram.

"Still, we are short of evidence for which medications can be used to treat grooming disorders," Dr. Jesus said.

He presented data on a case series of three Brazilian and three Portuguese patients, four of whom had SPD, one with trichotillomania, and one with both disorders secondary to conditions that included bipolar disorder, major depressive disorder, generalized anxiety disorder, and dysthymia.

Previous medications tried for their compulsive behaviors included lithium, quetiapine, fluoxetine, venlafaxine, oxcarbazepine, and gabapentin.

Two patients had complete abstinence from SPD for 10-12 months while taking NAC 1,200 mg daily. One of these patients had a relapse after 2 weeks off NAC and improved after restarting the drug. The second patient had a relapse 1 month after stopping the drug and also had improvement after restarting it, this time at a dose of 1,800 mg/day. This patient also had trichotillomania that was considered "greatly improved" with NAC 1,200 mg/day.

The remaining patients all had "great improvement" of SPD, and three had improvement of symptoms when they restarted the drug after hiatuses ranging from 2 weeks to 3 months.

Dr. Jesus emphasized that NAC treated the compulsive grooming symptoms only and not the underlying disorder. For example, one patient with SPD secondary to major depressive disorder also had pathologic jealousy and an addiction to the Internet; NAC did not diminish symptoms of either the jealousy or the addiction.

There has been only one small, randomized, double-blind placebo-controlled trial of NAC in trichotillomania to date, Dr. Jesus noted. The investigators of that study found that patients in the active treatment group had significant improvement of symptoms on both the Massachusetts General Hospital Hair Pulling Scale and the Psychiatric Institute Trichotillomania Scale (P = .001). They also found that more than half of the 50 patients were "much" or "very much" improved with NAC, compared with patients on placebo (P = .003).

Dr. Jesus did not disclose the funding source for the study but reported having no significant financial disclosures or relationships with the manufacturers of any products he discussed.

NEW YORK – The safe, cheap, readily available medication N-acetylcysteine may be effective against difficult-to-treat compulsive grooming disorders, a trans-Atlantic study showed.

In a case series of six patients treated for trichotillomania (hair pulling) and/or skin excoriation (skin-picking disorder, or SPD) as comorbidities to an impulse control or affective disorder, treatment with N-acetylcysteine (NAC) 1,200-1,800 mg/day resulted in either complete abstinence or great improvement in self-damaging habits, said Dr. Gustavo Jesus of the Central Psychiatric Hospital of Lisbon.

Most cases show very good results of the use of NAC in difficult-to-treat grooming disorders, he said at the American Psychiatric Association annual meeting.

Although support for the use of NAC in grooming disorders comes largely from case reports, the available evidence supports his team’s findings, he added.

Neil Osterweil/Frontline Medical News

NAC is a precursor to cysteine, an amino acid that protects cells from oxidative stress, interacts with inflammatory mediators, and is a modulator of the glutaminergic system of neurotransmission.

The medication historically has been used to counteract acetaminophen overdose, as a mucolytic agent for the treatment of respiratory diseases, and in the treatment of contrast-induced nephropathy, polycystic ovary syndrome, and more recently, psychiatric disorders, because of its antioxidative and anti-inflammatory properties.

The agent has been studied most in schizophrenia, Dr. Jesus said, but has also been investigated in bipolar and depressive disorders, substance use problems, obsessive-compulsive disorders and impulse control disorders, including grooming disorders.

Few options

Dr. Jesus’s team, with colleagues in São Paulo, Brazil, reviewed the literature for drug treatment of trichotillomania, and found varying evidence for the use of clomipramine, desipramine, fluoxetine, olanzapine, naltrexone, and citalopram.

"Still, we are short of evidence for which medications can be used to treat grooming disorders," Dr. Jesus said.

He presented data on a case series of three Brazilian and three Portuguese patients, four of whom had SPD, one with trichotillomania, and one with both disorders secondary to conditions that included bipolar disorder, major depressive disorder, generalized anxiety disorder, and dysthymia.

Previous medications tried for their compulsive behaviors included lithium, quetiapine, fluoxetine, venlafaxine, oxcarbazepine, and gabapentin.

Two patients had complete abstinence from SPD for 10-12 months while taking NAC 1,200 mg daily. One of these patients had a relapse after 2 weeks off NAC and improved after restarting the drug. The second patient had a relapse 1 month after stopping the drug and also had improvement after restarting it, this time at a dose of 1,800 mg/day. This patient also had trichotillomania that was considered "greatly improved" with NAC 1,200 mg/day.

The remaining patients all had "great improvement" of SPD, and three had improvement of symptoms when they restarted the drug after hiatuses ranging from 2 weeks to 3 months.

Dr. Jesus emphasized that NAC treated the compulsive grooming symptoms only and not the underlying disorder. For example, one patient with SPD secondary to major depressive disorder also had pathologic jealousy and an addiction to the Internet; NAC did not diminish symptoms of either the jealousy or the addiction.

There has been only one small, randomized, double-blind placebo-controlled trial of NAC in trichotillomania to date, Dr. Jesus noted. The investigators of that study found that patients in the active treatment group had significant improvement of symptoms on both the Massachusetts General Hospital Hair Pulling Scale and the Psychiatric Institute Trichotillomania Scale (P = .001). They also found that more than half of the 50 patients were "much" or "very much" improved with NAC, compared with patients on placebo (P = .003).

Dr. Jesus did not disclose the funding source for the study but reported having no significant financial disclosures or relationships with the manufacturers of any products he discussed.

NEW YORK – The safe, cheap, readily available medication N-acetylcysteine may be effective against difficult-to-treat compulsive grooming disorders, a trans-Atlantic study showed.

In a case series of six patients treated for trichotillomania (hair pulling) and/or skin excoriation (skin-picking disorder, or SPD) as comorbidities to an impulse control or affective disorder, treatment with N-acetylcysteine (NAC) 1,200-1,800 mg/day resulted in either complete abstinence or great improvement in self-damaging habits, said Dr. Gustavo Jesus of the Central Psychiatric Hospital of Lisbon.

Most cases show very good results of the use of NAC in difficult-to-treat grooming disorders, he said at the American Psychiatric Association annual meeting.

Although support for the use of NAC in grooming disorders comes largely from case reports, the available evidence supports his team’s findings, he added.

Neil Osterweil/Frontline Medical News

NAC is a precursor to cysteine, an amino acid that protects cells from oxidative stress, interacts with inflammatory mediators, and is a modulator of the glutaminergic system of neurotransmission.

The medication historically has been used to counteract acetaminophen overdose, as a mucolytic agent for the treatment of respiratory diseases, and in the treatment of contrast-induced nephropathy, polycystic ovary syndrome, and more recently, psychiatric disorders, because of its antioxidative and anti-inflammatory properties.

The agent has been studied most in schizophrenia, Dr. Jesus said, but has also been investigated in bipolar and depressive disorders, substance use problems, obsessive-compulsive disorders and impulse control disorders, including grooming disorders.

Few options

Dr. Jesus’s team, with colleagues in São Paulo, Brazil, reviewed the literature for drug treatment of trichotillomania, and found varying evidence for the use of clomipramine, desipramine, fluoxetine, olanzapine, naltrexone, and citalopram.

"Still, we are short of evidence for which medications can be used to treat grooming disorders," Dr. Jesus said.

He presented data on a case series of three Brazilian and three Portuguese patients, four of whom had SPD, one with trichotillomania, and one with both disorders secondary to conditions that included bipolar disorder, major depressive disorder, generalized anxiety disorder, and dysthymia.

Previous medications tried for their compulsive behaviors included lithium, quetiapine, fluoxetine, venlafaxine, oxcarbazepine, and gabapentin.

Two patients had complete abstinence from SPD for 10-12 months while taking NAC 1,200 mg daily. One of these patients had a relapse after 2 weeks off NAC and improved after restarting the drug. The second patient had a relapse 1 month after stopping the drug and also had improvement after restarting it, this time at a dose of 1,800 mg/day. This patient also had trichotillomania that was considered "greatly improved" with NAC 1,200 mg/day.

The remaining patients all had "great improvement" of SPD, and three had improvement of symptoms when they restarted the drug after hiatuses ranging from 2 weeks to 3 months.

Dr. Jesus emphasized that NAC treated the compulsive grooming symptoms only and not the underlying disorder. For example, one patient with SPD secondary to major depressive disorder also had pathologic jealousy and an addiction to the Internet; NAC did not diminish symptoms of either the jealousy or the addiction.

There has been only one small, randomized, double-blind placebo-controlled trial of NAC in trichotillomania to date, Dr. Jesus noted. The investigators of that study found that patients in the active treatment group had significant improvement of symptoms on both the Massachusetts General Hospital Hair Pulling Scale and the Psychiatric Institute Trichotillomania Scale (P = .001). They also found that more than half of the 50 patients were "much" or "very much" improved with NAC, compared with patients on placebo (P = .003).

Dr. Jesus did not disclose the funding source for the study but reported having no significant financial disclosures or relationships with the manufacturers of any products he discussed.

Bipolar disorder patients perform worse than do their counterparts without-bipolar disorder at language comprehension tests at the behavioral level, but not the physiological level, according to findings from a small-scale study.

A team of researchers from CHU Sainte Marguerite and Aix-Marseille Université, Marseille, France, examined behavioral and electrophysiological responses to speech by measuring the "N400 effect," an ERP (event-related brain potential) observed in patients with bipolar disorder and schizophrenia that typically is provoked via the subjects’ response to unexpected or incongruous words at the end of a sentence.

Led by Dr. Michel Cermolacce of CHU Sainte Marguerite, the team compared responses from 38 participants, including 19 bipolar type I patients and 19 healthy comparison subjects. The patients with bipolar disorder were recruited from the Marseille University Department of Psychiatry while presenting a mild to severe manic episode and did not have concurrent neurological disorders (J. Affect. Disord. 2014;158:161-71).

The participants in the study were asked to listen to a series of congruous and incongruous complete sentences and judge whether the last word of each sentence was congruous or incongruous. The subjects’ brain waves were measured throughout the test with an electroencephalogram.

The study participants with bipolar disorder exhibited a lower rate of correct responses for both congruous endings (76.7%, compared to 80% from healthy subjects) and incongruous endings (75% in patients with bipolar disorder, and 80% from healthy subjects). In addition, bipolar patients had longer response times when looking for congruous endings than their peers did (1,120 ms compared to 970 ms for healthy subjects.)

However, EEG readings showed preserved amplitude but delayed latency in difference waves, suggesting no significant disruption of brain waves through the N400. The authors noted that the findings contrast with the only previous N400 study, which showed a disruption of brain waves that is in line with similar results found in patients with schizophrenia (Prog. Neuropsychopharmacol. Biol. Psychiatry 2012;38:194-200). The previous study used visually presented word pairs rather than verbal word pairs, an approach the authors contend does not reflect a natural language setting.

Dr. Cermolacce and his colleagues cited several limitations, including the study’s small sample size and the absence of a group of patients with schizophrenia.

However, the findings suggest that specificity and adherence to natural speech patterns should be taken into account when examining speech disruptions in patients with mental disorders in a research setting, they noted.

"The discrepancy in manic patients between (i) preserved N400 and (ii) delayed [Late Positive Component] and impaired behavioral performances under natural speech conditions can be interpreted as reflecting non-specific cognitive rather than primary language alterations in line with previous behavioral findings," they wrote.

The authors report no conflict of interest.

[email protected]

Bipolar disorder patients perform worse than do their counterparts without-bipolar disorder at language comprehension tests at the behavioral level, but not the physiological level, according to findings from a small-scale study.

A team of researchers from CHU Sainte Marguerite and Aix-Marseille Université, Marseille, France, examined behavioral and electrophysiological responses to speech by measuring the "N400 effect," an ERP (event-related brain potential) observed in patients with bipolar disorder and schizophrenia that typically is provoked via the subjects’ response to unexpected or incongruous words at the end of a sentence.

Led by Dr. Michel Cermolacce of CHU Sainte Marguerite, the team compared responses from 38 participants, including 19 bipolar type I patients and 19 healthy comparison subjects. The patients with bipolar disorder were recruited from the Marseille University Department of Psychiatry while presenting a mild to severe manic episode and did not have concurrent neurological disorders (J. Affect. Disord. 2014;158:161-71).

The participants in the study were asked to listen to a series of congruous and incongruous complete sentences and judge whether the last word of each sentence was congruous or incongruous. The subjects’ brain waves were measured throughout the test with an electroencephalogram.

The study participants with bipolar disorder exhibited a lower rate of correct responses for both congruous endings (76.7%, compared to 80% from healthy subjects) and incongruous endings (75% in patients with bipolar disorder, and 80% from healthy subjects). In addition, bipolar patients had longer response times when looking for congruous endings than their peers did (1,120 ms compared to 970 ms for healthy subjects.)

However, EEG readings showed preserved amplitude but delayed latency in difference waves, suggesting no significant disruption of brain waves through the N400. The authors noted that the findings contrast with the only previous N400 study, which showed a disruption of brain waves that is in line with similar results found in patients with schizophrenia (Prog. Neuropsychopharmacol. Biol. Psychiatry 2012;38:194-200). The previous study used visually presented word pairs rather than verbal word pairs, an approach the authors contend does not reflect a natural language setting.

Dr. Cermolacce and his colleagues cited several limitations, including the study’s small sample size and the absence of a group of patients with schizophrenia.

However, the findings suggest that specificity and adherence to natural speech patterns should be taken into account when examining speech disruptions in patients with mental disorders in a research setting, they noted.

"The discrepancy in manic patients between (i) preserved N400 and (ii) delayed [Late Positive Component] and impaired behavioral performances under natural speech conditions can be interpreted as reflecting non-specific cognitive rather than primary language alterations in line with previous behavioral findings," they wrote.

The authors report no conflict of interest.

[email protected]

Bipolar disorder patients perform worse than do their counterparts without-bipolar disorder at language comprehension tests at the behavioral level, but not the physiological level, according to findings from a small-scale study.

A team of researchers from CHU Sainte Marguerite and Aix-Marseille Université, Marseille, France, examined behavioral and electrophysiological responses to speech by measuring the "N400 effect," an ERP (event-related brain potential) observed in patients with bipolar disorder and schizophrenia that typically is provoked via the subjects’ response to unexpected or incongruous words at the end of a sentence.

Led by Dr. Michel Cermolacce of CHU Sainte Marguerite, the team compared responses from 38 participants, including 19 bipolar type I patients and 19 healthy comparison subjects. The patients with bipolar disorder were recruited from the Marseille University Department of Psychiatry while presenting a mild to severe manic episode and did not have concurrent neurological disorders (J. Affect. Disord. 2014;158:161-71).

The participants in the study were asked to listen to a series of congruous and incongruous complete sentences and judge whether the last word of each sentence was congruous or incongruous. The subjects’ brain waves were measured throughout the test with an electroencephalogram.

The study participants with bipolar disorder exhibited a lower rate of correct responses for both congruous endings (76.7%, compared to 80% from healthy subjects) and incongruous endings (75% in patients with bipolar disorder, and 80% from healthy subjects). In addition, bipolar patients had longer response times when looking for congruous endings than their peers did (1,120 ms compared to 970 ms for healthy subjects.)

However, EEG readings showed preserved amplitude but delayed latency in difference waves, suggesting no significant disruption of brain waves through the N400. The authors noted that the findings contrast with the only previous N400 study, which showed a disruption of brain waves that is in line with similar results found in patients with schizophrenia (Prog. Neuropsychopharmacol. Biol. Psychiatry 2012;38:194-200). The previous study used visually presented word pairs rather than verbal word pairs, an approach the authors contend does not reflect a natural language setting.

Dr. Cermolacce and his colleagues cited several limitations, including the study’s small sample size and the absence of a group of patients with schizophrenia.

However, the findings suggest that specificity and adherence to natural speech patterns should be taken into account when examining speech disruptions in patients with mental disorders in a research setting, they noted.

"The discrepancy in manic patients between (i) preserved N400 and (ii) delayed [Late Positive Component] and impaired behavioral performances under natural speech conditions can be interpreted as reflecting non-specific cognitive rather than primary language alterations in line with previous behavioral findings," they wrote.

The authors report no conflict of interest.

[email protected]

Mismatch negativity on EEG examination is altered among young adults who engage in risky drinking behavior, compared with nondrinkers, and is even more pronounced among people who report risky alcohol use and also have bipolar disorder, a recently published report shows.

Mismatch negativity refers to the automatic electrical activity that occurs in the brain in response to auditory stimulation that incorporates a deviation in a sequence of sounds, and reductions in mismatch negativity are a marker for impairment of NMDA (N-methyl-D-aspartate)-receptor activation. NMDA receptors are thought to be compromised already by alcohol use and in patients with bipolar disorder.

To examine the effects of alcohol use and bipolar disorder on mismatch negativity, EEG with auditory stimuli was performed on 42 bipolar disorder patients and 34 control subjects aged 16-30 years, reported Kate M. Chitty, a PhD candidate at the University of Sydney, Australia, and her associates.

Sixteen of the bipolar disorder patients and 14 of the control subjects engaged in high-risk drinking, while 26 of the patients with bipolar disorder and 20 of the control subjects did not. Alcohol misuse was found to be a strong predictor of attenuations in mismatch negativity, and alcohol’s effect was even more pronounced in bipolar disorder patients than in control subjects. "The attenuated mismatch negativity may reflect an additive effect of alcohol’s antagonistic actions on an already perturbed NMDA/glutamatergic system," the investigators said (Biol. Psychol. 2014;99:60-8).

"Just as glutamatergic agents are becoming increasingly popular in the treatment of bipolar disease, our results suggest that limiting alcohol use could help to control glutamatergic regulation and may be a crucial first step prior to initiating such treatment," they added.

Youths with bipolar disorder have reported lifetime rates of alcohol misuse of up to 70%, and one recent study found that the demographic group most likely to participate in weekly substance use was 20- to 30-year-old males with bipolar disorder, reported Ms. Chitty, who is affiliated with the university’s clinical research unit at the Brain and Mind Research Institute.

Ms. Chitty and her associates cited several limitations of their study. For example, because participants under age 18 years are unable to buy alcohol legally in Australia, it is possible those minors might have been inclined to underreport their alcohol use. Also, the assessment of alcohol use was based on self-report answers to the AUDIT (alcohol use disorder identification test), which is designed to access alcohol use over the last year. "Therefore, information regarding the duration and intensity of the drinking habits beyond this timeframe is limited," they wrote.

Nevertheless, the study suggests that limiting alcohol use might help control glutamatergic regulation and "may be a crucial first step prior to initiating" the treatment of bipolar disorder, Ms. Chitty and her associates wrote.

This study was funded by Australia’s National Health and Medical Research Council; and the New South Wales Health, Mental Health and Drug & Alcohol Office. Ms. Chitty and her associates reported no financial conflicts of interest.

Mismatch negativity on EEG examination is altered among young adults who engage in risky drinking behavior, compared with nondrinkers, and is even more pronounced among people who report risky alcohol use and also have bipolar disorder, a recently published report shows.

Mismatch negativity refers to the automatic electrical activity that occurs in the brain in response to auditory stimulation that incorporates a deviation in a sequence of sounds, and reductions in mismatch negativity are a marker for impairment of NMDA (N-methyl-D-aspartate)-receptor activation. NMDA receptors are thought to be compromised already by alcohol use and in patients with bipolar disorder.

To examine the effects of alcohol use and bipolar disorder on mismatch negativity, EEG with auditory stimuli was performed on 42 bipolar disorder patients and 34 control subjects aged 16-30 years, reported Kate M. Chitty, a PhD candidate at the University of Sydney, Australia, and her associates.

Sixteen of the bipolar disorder patients and 14 of the control subjects engaged in high-risk drinking, while 26 of the patients with bipolar disorder and 20 of the control subjects did not. Alcohol misuse was found to be a strong predictor of attenuations in mismatch negativity, and alcohol’s effect was even more pronounced in bipolar disorder patients than in control subjects. "The attenuated mismatch negativity may reflect an additive effect of alcohol’s antagonistic actions on an already perturbed NMDA/glutamatergic system," the investigators said (Biol. Psychol. 2014;99:60-8).

"Just as glutamatergic agents are becoming increasingly popular in the treatment of bipolar disease, our results suggest that limiting alcohol use could help to control glutamatergic regulation and may be a crucial first step prior to initiating such treatment," they added.

Youths with bipolar disorder have reported lifetime rates of alcohol misuse of up to 70%, and one recent study found that the demographic group most likely to participate in weekly substance use was 20- to 30-year-old males with bipolar disorder, reported Ms. Chitty, who is affiliated with the university’s clinical research unit at the Brain and Mind Research Institute.

Ms. Chitty and her associates cited several limitations of their study. For example, because participants under age 18 years are unable to buy alcohol legally in Australia, it is possible those minors might have been inclined to underreport their alcohol use. Also, the assessment of alcohol use was based on self-report answers to the AUDIT (alcohol use disorder identification test), which is designed to access alcohol use over the last year. "Therefore, information regarding the duration and intensity of the drinking habits beyond this timeframe is limited," they wrote.

Nevertheless, the study suggests that limiting alcohol use might help control glutamatergic regulation and "may be a crucial first step prior to initiating" the treatment of bipolar disorder, Ms. Chitty and her associates wrote.

This study was funded by Australia’s National Health and Medical Research Council; and the New South Wales Health, Mental Health and Drug & Alcohol Office. Ms. Chitty and her associates reported no financial conflicts of interest.

Mismatch negativity on EEG examination is altered among young adults who engage in risky drinking behavior, compared with nondrinkers, and is even more pronounced among people who report risky alcohol use and also have bipolar disorder, a recently published report shows.

Mismatch negativity refers to the automatic electrical activity that occurs in the brain in response to auditory stimulation that incorporates a deviation in a sequence of sounds, and reductions in mismatch negativity are a marker for impairment of NMDA (N-methyl-D-aspartate)-receptor activation. NMDA receptors are thought to be compromised already by alcohol use and in patients with bipolar disorder.

To examine the effects of alcohol use and bipolar disorder on mismatch negativity, EEG with auditory stimuli was performed on 42 bipolar disorder patients and 34 control subjects aged 16-30 years, reported Kate M. Chitty, a PhD candidate at the University of Sydney, Australia, and her associates.

Sixteen of the bipolar disorder patients and 14 of the control subjects engaged in high-risk drinking, while 26 of the patients with bipolar disorder and 20 of the control subjects did not. Alcohol misuse was found to be a strong predictor of attenuations in mismatch negativity, and alcohol’s effect was even more pronounced in bipolar disorder patients than in control subjects. "The attenuated mismatch negativity may reflect an additive effect of alcohol’s antagonistic actions on an already perturbed NMDA/glutamatergic system," the investigators said (Biol. Psychol. 2014;99:60-8).

"Just as glutamatergic agents are becoming increasingly popular in the treatment of bipolar disease, our results suggest that limiting alcohol use could help to control glutamatergic regulation and may be a crucial first step prior to initiating such treatment," they added.

Youths with bipolar disorder have reported lifetime rates of alcohol misuse of up to 70%, and one recent study found that the demographic group most likely to participate in weekly substance use was 20- to 30-year-old males with bipolar disorder, reported Ms. Chitty, who is affiliated with the university’s clinical research unit at the Brain and Mind Research Institute.

Ms. Chitty and her associates cited several limitations of their study. For example, because participants under age 18 years are unable to buy alcohol legally in Australia, it is possible those minors might have been inclined to underreport their alcohol use. Also, the assessment of alcohol use was based on self-report answers to the AUDIT (alcohol use disorder identification test), which is designed to access alcohol use over the last year. "Therefore, information regarding the duration and intensity of the drinking habits beyond this timeframe is limited," they wrote.

Nevertheless, the study suggests that limiting alcohol use might help control glutamatergic regulation and "may be a crucial first step prior to initiating" the treatment of bipolar disorder, Ms. Chitty and her associates wrote.

This study was funded by Australia’s National Health and Medical Research Council; and the New South Wales Health, Mental Health and Drug & Alcohol Office. Ms. Chitty and her associates reported no financial conflicts of interest.

CHICAGO – If you’re currently treating any pregnant patients who are taking atypical antipsychotics, Dr. Marlene P. Freeman and her colleagues, who’ve started a national registry for tracking these data, hope to hear from you.

"We also need information not just on patients who are taking antipsychotics but also on those who aren’t, so that we can expand the number of controls," Dr. Freeman said in an interview during Psychiatry Update 2014, cosponsored by the American Academy of Clinical Psychiatrists and Current Psychiatry.

"Our registry is carefully, prospectively done," said Dr. Freeman while speaking at the meeting. "It’s all done by phone, with two calls during pregnancy and one post partum."

Findings based on data collected before June 2013 and presented at a teratogenicity meeting last year were "not unblinded in terms of what medications were associated with what outcomes or who the controls were," she said. However, so far the trend is that antipsychotic use isn’t likely going to turn out to be as adverse as valproic acid, the anticonvulsant that ultimately was found associated with teratogenicity, said Dr. Freeman, who is the clinical director of Women’s Mental Health Center at Massachusetts General Hospital in Boston, where the registry is housed. "Rates of malformations [found in the registry data so far] were at or below the rates in the general population," she said, adding that definitive results are still needed.

At this time, more than 400 patients are enrolled in the registry, which began in 2011 in an effort to build a definitive database on teratogenicity and atypicals in pregnancy. According to Dr. Freeman, a German study published recently showed no significant difference between rates of major malformations between those exposed to first-generation antipsychotics or second-generation atypicals during the first trimester (J. Clin. Psychopharm. 2013;33:453-62). However, compared with controls, the major malformation rate was just over two times greater among those exposed to atypicals.

Meanwhile, a prospective Canadian study also cited by Dr. Freeman did not find a significant difference in congenital malformations between children born to mothers taking atypicals, compared with controls (BMJ Open 2013;3:e003062 [doi:10.1136/bmjopen-2013-003062]).

According to Dr. Freeman, the need for clear, substantial data is important, because the use of atypicals in pregnancy is on the rise. A study published last year and cited by Dr. Freeman found that among 585,615 U.S. deliveries that occurred during 2001-2007 with prescriptions dispensed to the mother between 60 days before or on the date of delivery, 0.72% received an atypical antipsychotic and 0.09% received a typical antipsychotic (Arch. Womens Ment. Health 2013;16:149-57). There was a 2.5-fold increase in atypicals prescribed over the course of the study period. Depression was the most common mental health diagnosis (63%), followed by bipolar disorder (43%), and schizophrenia (13%).

Dr. Freeman disclosed she has industry relationships with GlaxoSmithKline, Takeda/Lundbeck, and Genentech, among others. Current Psychiatry and this news organization are owned by the same parent company.

For more information on the National Pregnancy Registry, click here.

[email protected]

On Twitter @whitneymcknight

CHICAGO – If you’re currently treating any pregnant patients who are taking atypical antipsychotics, Dr. Marlene P. Freeman and her colleagues, who’ve started a national registry for tracking these data, hope to hear from you.

"We also need information not just on patients who are taking antipsychotics but also on those who aren’t, so that we can expand the number of controls," Dr. Freeman said in an interview during Psychiatry Update 2014, cosponsored by the American Academy of Clinical Psychiatrists and Current Psychiatry.

"Our registry is carefully, prospectively done," said Dr. Freeman while speaking at the meeting. "It’s all done by phone, with two calls during pregnancy and one post partum."

Findings based on data collected before June 2013 and presented at a teratogenicity meeting last year were "not unblinded in terms of what medications were associated with what outcomes or who the controls were," she said. However, so far the trend is that antipsychotic use isn’t likely going to turn out to be as adverse as valproic acid, the anticonvulsant that ultimately was found associated with teratogenicity, said Dr. Freeman, who is the clinical director of Women’s Mental Health Center at Massachusetts General Hospital in Boston, where the registry is housed. "Rates of malformations [found in the registry data so far] were at or below the rates in the general population," she said, adding that definitive results are still needed.

At this time, more than 400 patients are enrolled in the registry, which began in 2011 in an effort to build a definitive database on teratogenicity and atypicals in pregnancy. According to Dr. Freeman, a German study published recently showed no significant difference between rates of major malformations between those exposed to first-generation antipsychotics or second-generation atypicals during the first trimester (J. Clin. Psychopharm. 2013;33:453-62). However, compared with controls, the major malformation rate was just over two times greater among those exposed to atypicals.

Meanwhile, a prospective Canadian study also cited by Dr. Freeman did not find a significant difference in congenital malformations between children born to mothers taking atypicals, compared with controls (BMJ Open 2013;3:e003062 [doi:10.1136/bmjopen-2013-003062]).

According to Dr. Freeman, the need for clear, substantial data is important, because the use of atypicals in pregnancy is on the rise. A study published last year and cited by Dr. Freeman found that among 585,615 U.S. deliveries that occurred during 2001-2007 with prescriptions dispensed to the mother between 60 days before or on the date of delivery, 0.72% received an atypical antipsychotic and 0.09% received a typical antipsychotic (Arch. Womens Ment. Health 2013;16:149-57). There was a 2.5-fold increase in atypicals prescribed over the course of the study period. Depression was the most common mental health diagnosis (63%), followed by bipolar disorder (43%), and schizophrenia (13%).

Dr. Freeman disclosed she has industry relationships with GlaxoSmithKline, Takeda/Lundbeck, and Genentech, among others. Current Psychiatry and this news organization are owned by the same parent company.

For more information on the National Pregnancy Registry, click here.

[email protected]

On Twitter @whitneymcknight

CHICAGO – If you’re currently treating any pregnant patients who are taking atypical antipsychotics, Dr. Marlene P. Freeman and her colleagues, who’ve started a national registry for tracking these data, hope to hear from you.

"We also need information not just on patients who are taking antipsychotics but also on those who aren’t, so that we can expand the number of controls," Dr. Freeman said in an interview during Psychiatry Update 2014, cosponsored by the American Academy of Clinical Psychiatrists and Current Psychiatry.

"Our registry is carefully, prospectively done," said Dr. Freeman while speaking at the meeting. "It’s all done by phone, with two calls during pregnancy and one post partum."

Findings based on data collected before June 2013 and presented at a teratogenicity meeting last year were "not unblinded in terms of what medications were associated with what outcomes or who the controls were," she said. However, so far the trend is that antipsychotic use isn’t likely going to turn out to be as adverse as valproic acid, the anticonvulsant that ultimately was found associated with teratogenicity, said Dr. Freeman, who is the clinical director of Women’s Mental Health Center at Massachusetts General Hospital in Boston, where the registry is housed. "Rates of malformations [found in the registry data so far] were at or below the rates in the general population," she said, adding that definitive results are still needed.

At this time, more than 400 patients are enrolled in the registry, which began in 2011 in an effort to build a definitive database on teratogenicity and atypicals in pregnancy. According to Dr. Freeman, a German study published recently showed no significant difference between rates of major malformations between those exposed to first-generation antipsychotics or second-generation atypicals during the first trimester (J. Clin. Psychopharm. 2013;33:453-62). However, compared with controls, the major malformation rate was just over two times greater among those exposed to atypicals.

Meanwhile, a prospective Canadian study also cited by Dr. Freeman did not find a significant difference in congenital malformations between children born to mothers taking atypicals, compared with controls (BMJ Open 2013;3:e003062 [doi:10.1136/bmjopen-2013-003062]).

According to Dr. Freeman, the need for clear, substantial data is important, because the use of atypicals in pregnancy is on the rise. A study published last year and cited by Dr. Freeman found that among 585,615 U.S. deliveries that occurred during 2001-2007 with prescriptions dispensed to the mother between 60 days before or on the date of delivery, 0.72% received an atypical antipsychotic and 0.09% received a typical antipsychotic (Arch. Womens Ment. Health 2013;16:149-57). There was a 2.5-fold increase in atypicals prescribed over the course of the study period. Depression was the most common mental health diagnosis (63%), followed by bipolar disorder (43%), and schizophrenia (13%).

Dr. Freeman disclosed she has industry relationships with GlaxoSmithKline, Takeda/Lundbeck, and Genentech, among others. Current Psychiatry and this news organization are owned by the same parent company.

For more information on the National Pregnancy Registry, click here.

[email protected]

On Twitter @whitneymcknight

Patients with schizophrenia, bipolar disorder, or depression have a significantly increased risk of tobacco-related mortality.

Among more than 591,000 such patients, tobacco-related deaths were about doubled, compared with the general population, Russell C. Callaghan, Ph.D., and his colleagues reported (J. Psych. Res. 2014;48:102-10).

In the study, the researchers analyzed the death records of patients who had been hospitalized with an ICD-9 primary psychiatric diagnosis in California between 1990 and 2005. Mortality estimates for conditions related to tobacco use comprised 53% of the total deaths in the schizophrenia cohort, 48% of deaths in the bipolar cohort, and 50% in the depression cohort, wrote Dr. Callaghan, associate professor in the Northern Medical Program at the University of Northern British Columbia, Prince George, and his associates.

©ricky_68fr/fotolia.com

The SMRs (standardized mortality ratios) for tobacco-related conditions were 2.45 for those in the schizophrenia group, 1.57 for the bipolar cohort, and 1.95 for the depression cohort. Cancer deaths were elevated among those with schizophrenia and depression, with SMRs of 1.3 among those with schizophrenia and 1.22 among those with depression. The risk was not increased among those with bipolar disorder, a finding that the investigators found to be surprising.

In addition, the schizophrenia, bipolar disorder, and depression groups all had increased rates of cardiovascular disease (SMRs of 2.46, 1.56, and 1.95, respectively). They also showed significantly higher SMRs for respiratory diseases (3.7, 2.4, and 2.7), wrote Dr. Callaghan, who also is affiliated with the Centre for Addiction and Mental Health in Toronto, and his associates.

Two factors are probably driving the excess mortality, they noted: insufficient tobacco use counseling and treatment, and the absence of regular cancer screenings.

The investigators cited several limitations. Because their cohort assignment algorithm "relied upon inpatient ICD-9 diagnoses of schizophrenia, bipolar disorder, and depression," the sample is based on those with fairly severe illness and might not have included those who had limited access to care. In addition, the medical records that were examined did not include information about the "presence, frequency, intensity, or duration of tobacco use," they wrote.

Despite those limitations, the findings suggest that addressing tobacco use in those groups is a "critical clinical and public health concern," they said.

"Our results stand as a call for increased recognition of the full harmful impact of tobacco use in these populations, as well as the urgent need to develop and implement strategies to reduce tobacco-related harms," Dr. Callaghan and his associates wrote.

The study was sponsored by the Centre for Addiction and Mental Health. The authors reported that they had no conflicts of interest.

[email protected]

On Twitter @Alz_Gal

Patients with schizophrenia, bipolar disorder, or depression have a significantly increased risk of tobacco-related mortality.

Among more than 591,000 such patients, tobacco-related deaths were about doubled, compared with the general population, Russell C. Callaghan, Ph.D., and his colleagues reported (J. Psych. Res. 2014;48:102-10).

In the study, the researchers analyzed the death records of patients who had been hospitalized with an ICD-9 primary psychiatric diagnosis in California between 1990 and 2005. Mortality estimates for conditions related to tobacco use comprised 53% of the total deaths in the schizophrenia cohort, 48% of deaths in the bipolar cohort, and 50% in the depression cohort, wrote Dr. Callaghan, associate professor in the Northern Medical Program at the University of Northern British Columbia, Prince George, and his associates.

©ricky_68fr/fotolia.com

The SMRs (standardized mortality ratios) for tobacco-related conditions were 2.45 for those in the schizophrenia group, 1.57 for the bipolar cohort, and 1.95 for the depression cohort. Cancer deaths were elevated among those with schizophrenia and depression, with SMRs of 1.3 among those with schizophrenia and 1.22 among those with depression. The risk was not increased among those with bipolar disorder, a finding that the investigators found to be surprising.

In addition, the schizophrenia, bipolar disorder, and depression groups all had increased rates of cardiovascular disease (SMRs of 2.46, 1.56, and 1.95, respectively). They also showed significantly higher SMRs for respiratory diseases (3.7, 2.4, and 2.7), wrote Dr. Callaghan, who also is affiliated with the Centre for Addiction and Mental Health in Toronto, and his associates.

Two factors are probably driving the excess mortality, they noted: insufficient tobacco use counseling and treatment, and the absence of regular cancer screenings.

The investigators cited several limitations. Because their cohort assignment algorithm "relied upon inpatient ICD-9 diagnoses of schizophrenia, bipolar disorder, and depression," the sample is based on those with fairly severe illness and might not have included those who had limited access to care. In addition, the medical records that were examined did not include information about the "presence, frequency, intensity, or duration of tobacco use," they wrote.

Despite those limitations, the findings suggest that addressing tobacco use in those groups is a "critical clinical and public health concern," they said.

"Our results stand as a call for increased recognition of the full harmful impact of tobacco use in these populations, as well as the urgent need to develop and implement strategies to reduce tobacco-related harms," Dr. Callaghan and his associates wrote.

The study was sponsored by the Centre for Addiction and Mental Health. The authors reported that they had no conflicts of interest.

[email protected]

On Twitter @Alz_Gal

Patients with schizophrenia, bipolar disorder, or depression have a significantly increased risk of tobacco-related mortality.

Among more than 591,000 such patients, tobacco-related deaths were about doubled, compared with the general population, Russell C. Callaghan, Ph.D., and his colleagues reported (J. Psych. Res. 2014;48:102-10).

In the study, the researchers analyzed the death records of patients who had been hospitalized with an ICD-9 primary psychiatric diagnosis in California between 1990 and 2005. Mortality estimates for conditions related to tobacco use comprised 53% of the total deaths in the schizophrenia cohort, 48% of deaths in the bipolar cohort, and 50% in the depression cohort, wrote Dr. Callaghan, associate professor in the Northern Medical Program at the University of Northern British Columbia, Prince George, and his associates.

©ricky_68fr/fotolia.com

The SMRs (standardized mortality ratios) for tobacco-related conditions were 2.45 for those in the schizophrenia group, 1.57 for the bipolar cohort, and 1.95 for the depression cohort. Cancer deaths were elevated among those with schizophrenia and depression, with SMRs of 1.3 among those with schizophrenia and 1.22 among those with depression. The risk was not increased among those with bipolar disorder, a finding that the investigators found to be surprising.

In addition, the schizophrenia, bipolar disorder, and depression groups all had increased rates of cardiovascular disease (SMRs of 2.46, 1.56, and 1.95, respectively). They also showed significantly higher SMRs for respiratory diseases (3.7, 2.4, and 2.7), wrote Dr. Callaghan, who also is affiliated with the Centre for Addiction and Mental Health in Toronto, and his associates.

Two factors are probably driving the excess mortality, they noted: insufficient tobacco use counseling and treatment, and the absence of regular cancer screenings.

The investigators cited several limitations. Because their cohort assignment algorithm "relied upon inpatient ICD-9 diagnoses of schizophrenia, bipolar disorder, and depression," the sample is based on those with fairly severe illness and might not have included those who had limited access to care. In addition, the medical records that were examined did not include information about the "presence, frequency, intensity, or duration of tobacco use," they wrote.

Despite those limitations, the findings suggest that addressing tobacco use in those groups is a "critical clinical and public health concern," they said.

"Our results stand as a call for increased recognition of the full harmful impact of tobacco use in these populations, as well as the urgent need to develop and implement strategies to reduce tobacco-related harms," Dr. Callaghan and his associates wrote.

The study was sponsored by the Centre for Addiction and Mental Health. The authors reported that they had no conflicts of interest.

[email protected]

On Twitter @Alz_Gal

Mania, the defining feature of bipolar disorder, is not the monolithic entity it is portrayed to be in the DSM-5, but instead has at least three distinct "subdimensions" that distinguish it from other mental disorders, according to a report in the Journal of Affective Disorders.

Researchers who found the DSM-5 portrayal of mania to be "unidimensional" and "misleading" sought to establish a more nuanced characterization by using detailed clinical interviews of 422 psychiatric outpatients to identify the key features unique to mania. These patients, predominantly women with a mean age of 42 years, were currently receiving mental health treatment; 17% had a diagnosis of bipolar disorder and 6% were in a manic episode at the time of the interview, said Camilo J. Ruggero, Ph.D., of the department of psychology, University of North Texas, Denton, and his associates.

Using the Interview for Mood and Anxiety Symptoms; the Structured Clinical Interview for DSM-IV Axis I Disorders; the Inventory of Depression and Anxiety Symptoms, Expanded Version; the Global Assessment of Functioning; and the Sheehan Disability Scale, the investigators identified three subdimensions that consistently characterized mania and distinguished it from other disorders: euphoric activation, which reflected increased energy; hyperactive cognition, which reflected flight of ideas, pressured speech, and distractibility; and reckless overconfidence, which reflected extreme overconfidence and resulting poor judgment and recklessness. The latter subdimension is similar to grandiosity but not necessarily delusional. A fourth subdimension, irritability, also was characteristic of mania but was not as unique to it as were the other three, since it can also occur in depression and other disorders (J. Affect. Disord. 2014;161:8-15).

After creating an instrument to reflect these four subdimensions of mania, Dr. Ruggero and his associates validated their findings in clinical interviews with a separate study population: 306 student volunteers who had a history of mental health treatment, 31% of whom were currently in treatment. All four subdimensions were highly prevalent in patients who had mania but not in those with other disorders.

Identifying these key subdimensions could elucidate the etiology of bipolar disorder. And, instead of focusing on "the higher-order syndrome" of mania, highlighting these subdimensions might help resolve discrepancies in results from pathophysiologic studies, since different facets of mania might reflect different pathophysiological processes, the researchers noted.

"Moreover, assessing distinct types of symptoms has important clinical implications; not all subdimensions affect functioning equally." For example, in these two patient populations, euphoric activation had little impact on participants’ daily functioning, compared with other symptoms, the researchers added.

Dr. Ruggero and his associates cited several limitations. Neither psychotic nor depressive symptoms were included in their analyses. Also, a few of the patients were in a current manic episode at the time of the study. Despite those limitations, their study "provides important new findings about mania. Future work can use these dimensions ... to better discern the pathophysiology of bipolar disorder," they wrote.

This work was supported in part by the Feldstein Medical Foundation. Dr. Ruggero and his associates reported no conflicts of interest.

Mania, the defining feature of bipolar disorder, is not the monolithic entity it is portrayed to be in the DSM-5, but instead has at least three distinct "subdimensions" that distinguish it from other mental disorders, according to a report in the Journal of Affective Disorders.

Researchers who found the DSM-5 portrayal of mania to be "unidimensional" and "misleading" sought to establish a more nuanced characterization by using detailed clinical interviews of 422 psychiatric outpatients to identify the key features unique to mania. These patients, predominantly women with a mean age of 42 years, were currently receiving mental health treatment; 17% had a diagnosis of bipolar disorder and 6% were in a manic episode at the time of the interview, said Camilo J. Ruggero, Ph.D., of the department of psychology, University of North Texas, Denton, and his associates.

Using the Interview for Mood and Anxiety Symptoms; the Structured Clinical Interview for DSM-IV Axis I Disorders; the Inventory of Depression and Anxiety Symptoms, Expanded Version; the Global Assessment of Functioning; and the Sheehan Disability Scale, the investigators identified three subdimensions that consistently characterized mania and distinguished it from other disorders: euphoric activation, which reflected increased energy; hyperactive cognition, which reflected flight of ideas, pressured speech, and distractibility; and reckless overconfidence, which reflected extreme overconfidence and resulting poor judgment and recklessness. The latter subdimension is similar to grandiosity but not necessarily delusional. A fourth subdimension, irritability, also was characteristic of mania but was not as unique to it as were the other three, since it can also occur in depression and other disorders (J. Affect. Disord. 2014;161:8-15).

After creating an instrument to reflect these four subdimensions of mania, Dr. Ruggero and his associates validated their findings in clinical interviews with a separate study population: 306 student volunteers who had a history of mental health treatment, 31% of whom were currently in treatment. All four subdimensions were highly prevalent in patients who had mania but not in those with other disorders.

Identifying these key subdimensions could elucidate the etiology of bipolar disorder. And, instead of focusing on "the higher-order syndrome" of mania, highlighting these subdimensions might help resolve discrepancies in results from pathophysiologic studies, since different facets of mania might reflect different pathophysiological processes, the researchers noted.

"Moreover, assessing distinct types of symptoms has important clinical implications; not all subdimensions affect functioning equally." For example, in these two patient populations, euphoric activation had little impact on participants’ daily functioning, compared with other symptoms, the researchers added.

Dr. Ruggero and his associates cited several limitations. Neither psychotic nor depressive symptoms were included in their analyses. Also, a few of the patients were in a current manic episode at the time of the study. Despite those limitations, their study "provides important new findings about mania. Future work can use these dimensions ... to better discern the pathophysiology of bipolar disorder," they wrote.

This work was supported in part by the Feldstein Medical Foundation. Dr. Ruggero and his associates reported no conflicts of interest.

Mania, the defining feature of bipolar disorder, is not the monolithic entity it is portrayed to be in the DSM-5, but instead has at least three distinct "subdimensions" that distinguish it from other mental disorders, according to a report in the Journal of Affective Disorders.

Researchers who found the DSM-5 portrayal of mania to be "unidimensional" and "misleading" sought to establish a more nuanced characterization by using detailed clinical interviews of 422 psychiatric outpatients to identify the key features unique to mania. These patients, predominantly women with a mean age of 42 years, were currently receiving mental health treatment; 17% had a diagnosis of bipolar disorder and 6% were in a manic episode at the time of the interview, said Camilo J. Ruggero, Ph.D., of the department of psychology, University of North Texas, Denton, and his associates.

Using the Interview for Mood and Anxiety Symptoms; the Structured Clinical Interview for DSM-IV Axis I Disorders; the Inventory of Depression and Anxiety Symptoms, Expanded Version; the Global Assessment of Functioning; and the Sheehan Disability Scale, the investigators identified three subdimensions that consistently characterized mania and distinguished it from other disorders: euphoric activation, which reflected increased energy; hyperactive cognition, which reflected flight of ideas, pressured speech, and distractibility; and reckless overconfidence, which reflected extreme overconfidence and resulting poor judgment and recklessness. The latter subdimension is similar to grandiosity but not necessarily delusional. A fourth subdimension, irritability, also was characteristic of mania but was not as unique to it as were the other three, since it can also occur in depression and other disorders (J. Affect. Disord. 2014;161:8-15).

After creating an instrument to reflect these four subdimensions of mania, Dr. Ruggero and his associates validated their findings in clinical interviews with a separate study population: 306 student volunteers who had a history of mental health treatment, 31% of whom were currently in treatment. All four subdimensions were highly prevalent in patients who had mania but not in those with other disorders.

Identifying these key subdimensions could elucidate the etiology of bipolar disorder. And, instead of focusing on "the higher-order syndrome" of mania, highlighting these subdimensions might help resolve discrepancies in results from pathophysiologic studies, since different facets of mania might reflect different pathophysiological processes, the researchers noted.

"Moreover, assessing distinct types of symptoms has important clinical implications; not all subdimensions affect functioning equally." For example, in these two patient populations, euphoric activation had little impact on participants’ daily functioning, compared with other symptoms, the researchers added.

Dr. Ruggero and his associates cited several limitations. Neither psychotic nor depressive symptoms were included in their analyses. Also, a few of the patients were in a current manic episode at the time of the study. Despite those limitations, their study "provides important new findings about mania. Future work can use these dimensions ... to better discern the pathophysiology of bipolar disorder," they wrote.

This work was supported in part by the Feldstein Medical Foundation. Dr. Ruggero and his associates reported no conflicts of interest.

Persons who committed suicide and lived at higher altitudes were significantly more likely to have bipolar disorder, compared with depression, schizophrenia, or anxiety disorders, researchers reported in the April issue of Medical Hypotheses.

Past research has found an association between altitude and suicide, even after controlling for gun ownership, rurality, age, and mental health access. The current study indicates that altitude preferentially affects suicide in bipolar disorder, said Rebekah S. Huber, a researcher at the University of Utah Brain Institute, Salt Lake City, and her associates.

The researchers performed random coefficient logistic regression modeling and least squares means on data for 35,725 suicides in 16 states and 809 counties that occurred during 2005-2008 and were reported to the Centers for Disease Control and Prevention’s National Violent Death Reporting System. The investigators assigned every decedent a single major diagnosis of bipolar disorder, major depressive disorder, schizophrenia, or anxiety disorder, and excluded infrequent diagnoses such as posttraumatic stress disorder or eating disorder.

Living at higher altitude was significantly associated with having coefficient (P = .004) and logistic regression (P = .001) models. Persons with bipolar disorder committed suicide at a higher mean altitude (1,205 meters) than did decedents with anxiety disorders (1,181), major depressive disorder (1,116), or schizophrenia (1,057).

The reason for the effect merits further study but might be tied to underlying mitochondrial dysfunction in bipolar disorder, lower levels of environmental lithium at higher altitudes, or diminished efficacy of bipolar disorder treatments at higher elevations, the investigators said (Med. Hypotheses 2014;82:377-81).

"Metabolic stress due to hypoxia may have important considerations for individuals with [bipolar disorder]," they added. "Hypoxia due to reduced oxygen partial pressure at higher altitudes may further decrease mitochondrial function in individuals with BD. For these individuals, metabolic changes associated with hypoxia may lead to depression, instability of mood, and increased risk of suicide."

The researchers cited several limitations. For example, the findings are based on results from far less than half of the 50 states, but "many states in the intermountain West are included," they wrote.

The VISN 19 Mental Illness Research and Education Center, the Utah Science Technology and Research Initiative, and the National Institutes of Health funded the research. The authors reported no conflicts of interest.

Persons who committed suicide and lived at higher altitudes were significantly more likely to have bipolar disorder, compared with depression, schizophrenia, or anxiety disorders, researchers reported in the April issue of Medical Hypotheses.

Past research has found an association between altitude and suicide, even after controlling for gun ownership, rurality, age, and mental health access. The current study indicates that altitude preferentially affects suicide in bipolar disorder, said Rebekah S. Huber, a researcher at the University of Utah Brain Institute, Salt Lake City, and her associates.

The researchers performed random coefficient logistic regression modeling and least squares means on data for 35,725 suicides in 16 states and 809 counties that occurred during 2005-2008 and were reported to the Centers for Disease Control and Prevention’s National Violent Death Reporting System. The investigators assigned every decedent a single major diagnosis of bipolar disorder, major depressive disorder, schizophrenia, or anxiety disorder, and excluded infrequent diagnoses such as posttraumatic stress disorder or eating disorder.

Living at higher altitude was significantly associated with having coefficient (P = .004) and logistic regression (P = .001) models. Persons with bipolar disorder committed suicide at a higher mean altitude (1,205 meters) than did decedents with anxiety disorders (1,181), major depressive disorder (1,116), or schizophrenia (1,057).

The reason for the effect merits further study but might be tied to underlying mitochondrial dysfunction in bipolar disorder, lower levels of environmental lithium at higher altitudes, or diminished efficacy of bipolar disorder treatments at higher elevations, the investigators said (Med. Hypotheses 2014;82:377-81).

"Metabolic stress due to hypoxia may have important considerations for individuals with [bipolar disorder]," they added. "Hypoxia due to reduced oxygen partial pressure at higher altitudes may further decrease mitochondrial function in individuals with BD. For these individuals, metabolic changes associated with hypoxia may lead to depression, instability of mood, and increased risk of suicide."

The researchers cited several limitations. For example, the findings are based on results from far less than half of the 50 states, but "many states in the intermountain West are included," they wrote.

The VISN 19 Mental Illness Research and Education Center, the Utah Science Technology and Research Initiative, and the National Institutes of Health funded the research. The authors reported no conflicts of interest.

Persons who committed suicide and lived at higher altitudes were significantly more likely to have bipolar disorder, compared with depression, schizophrenia, or anxiety disorders, researchers reported in the April issue of Medical Hypotheses.

Past research has found an association between altitude and suicide, even after controlling for gun ownership, rurality, age, and mental health access. The current study indicates that altitude preferentially affects suicide in bipolar disorder, said Rebekah S. Huber, a researcher at the University of Utah Brain Institute, Salt Lake City, and her associates.

The researchers performed random coefficient logistic regression modeling and least squares means on data for 35,725 suicides in 16 states and 809 counties that occurred during 2005-2008 and were reported to the Centers for Disease Control and Prevention’s National Violent Death Reporting System. The investigators assigned every decedent a single major diagnosis of bipolar disorder, major depressive disorder, schizophrenia, or anxiety disorder, and excluded infrequent diagnoses such as posttraumatic stress disorder or eating disorder.

Living at higher altitude was significantly associated with having coefficient (P = .004) and logistic regression (P = .001) models. Persons with bipolar disorder committed suicide at a higher mean altitude (1,205 meters) than did decedents with anxiety disorders (1,181), major depressive disorder (1,116), or schizophrenia (1,057).

The reason for the effect merits further study but might be tied to underlying mitochondrial dysfunction in bipolar disorder, lower levels of environmental lithium at higher altitudes, or diminished efficacy of bipolar disorder treatments at higher elevations, the investigators said (Med. Hypotheses 2014;82:377-81).

"Metabolic stress due to hypoxia may have important considerations for individuals with [bipolar disorder]," they added. "Hypoxia due to reduced oxygen partial pressure at higher altitudes may further decrease mitochondrial function in individuals with BD. For these individuals, metabolic changes associated with hypoxia may lead to depression, instability of mood, and increased risk of suicide."

The researchers cited several limitations. For example, the findings are based on results from far less than half of the 50 states, but "many states in the intermountain West are included," they wrote.

The VISN 19 Mental Illness Research and Education Center, the Utah Science Technology and Research Initiative, and the National Institutes of Health funded the research. The authors reported no conflicts of interest.

ORLANDO – Low-dose asenapine provided global improvement in symptoms and mood in older nondemented patients with bipolar disorder with prior suboptimal response to other therapies, according to a pilot study.

This atypical antipsychotic agent, which was used in the study at a mean daily dose of just 7.4 mg, is a novel therapy worth considering in selected geriatric patients with bipolar disorder, Dr. Martha N. Sajatovic said at the annual meeting of the American Association for Geriatric Psychiatry.

The 11 subjects who completed the study showed significant improvements on the Brief Psychiatric Rating Scale, on the Clinical Global Impression, Bipolar version, and on measures of mood symptoms. No changes were found from baseline in terms of mean body mass index, abnormal movement scores, blood glucose levels, lipid levels, or functional status as measured by the Short Form–12, or on the WHO-Disability Assessment Scale II.

Of the four study dropouts, one left because of elevated liver function test results, another because of the emergence of manic symptoms while on asenapine, and two others for reasons unrelated to the study medication, according to Dr. Sajatovic, professor of psychiatry and director of the geropsychiatry program at Case Western Reserve University, Cleveland.

The most common treatment-emergent adverse event was mild, transient GI discomfort, which affected one-third of participants.

The addition of asenapine to the armamentarium for bipolar disorder in later life is a welcome development, she said. Of the 6 million American adults with bipolar disorder, roughly 1 million are over the age of 60. Traditional mood stabilizers such as lithium often have limiting side effects in the older population, and treatment failures are common, she noted.

This pilot study was sponsored by NV Organon/Merck. Dr. Satajovic reported receiving research grants from Merck and other companies, as well as serving as a consultant to Prophase, Otsuka, Pfizer, Amgen, and United BioSource.

[email protected]

ORLANDO – Low-dose asenapine provided global improvement in symptoms and mood in older nondemented patients with bipolar disorder with prior suboptimal response to other therapies, according to a pilot study.

This atypical antipsychotic agent, which was used in the study at a mean daily dose of just 7.4 mg, is a novel therapy worth considering in selected geriatric patients with bipolar disorder, Dr. Martha N. Sajatovic said at the annual meeting of the American Association for Geriatric Psychiatry.

The 11 subjects who completed the study showed significant improvements on the Brief Psychiatric Rating Scale, on the Clinical Global Impression, Bipolar version, and on measures of mood symptoms. No changes were found from baseline in terms of mean body mass index, abnormal movement scores, blood glucose levels, lipid levels, or functional status as measured by the Short Form–12, or on the WHO-Disability Assessment Scale II.

Of the four study dropouts, one left because of elevated liver function test results, another because of the emergence of manic symptoms while on asenapine, and two others for reasons unrelated to the study medication, according to Dr. Sajatovic, professor of psychiatry and director of the geropsychiatry program at Case Western Reserve University, Cleveland.

The most common treatment-emergent adverse event was mild, transient GI discomfort, which affected one-third of participants.

The addition of asenapine to the armamentarium for bipolar disorder in later life is a welcome development, she said. Of the 6 million American adults with bipolar disorder, roughly 1 million are over the age of 60. Traditional mood stabilizers such as lithium often have limiting side effects in the older population, and treatment failures are common, she noted.

This pilot study was sponsored by NV Organon/Merck. Dr. Satajovic reported receiving research grants from Merck and other companies, as well as serving as a consultant to Prophase, Otsuka, Pfizer, Amgen, and United BioSource.

[email protected]

ORLANDO – Low-dose asenapine provided global improvement in symptoms and mood in older nondemented patients with bipolar disorder with prior suboptimal response to other therapies, according to a pilot study.

This atypical antipsychotic agent, which was used in the study at a mean daily dose of just 7.4 mg, is a novel therapy worth considering in selected geriatric patients with bipolar disorder, Dr. Martha N. Sajatovic said at the annual meeting of the American Association for Geriatric Psychiatry.

The 11 subjects who completed the study showed significant improvements on the Brief Psychiatric Rating Scale, on the Clinical Global Impression, Bipolar version, and on measures of mood symptoms. No changes were found from baseline in terms of mean body mass index, abnormal movement scores, blood glucose levels, lipid levels, or functional status as measured by the Short Form–12, or on the WHO-Disability Assessment Scale II.

Of the four study dropouts, one left because of elevated liver function test results, another because of the emergence of manic symptoms while on asenapine, and two others for reasons unrelated to the study medication, according to Dr. Sajatovic, professor of psychiatry and director of the geropsychiatry program at Case Western Reserve University, Cleveland.

The most common treatment-emergent adverse event was mild, transient GI discomfort, which affected one-third of participants.

The addition of asenapine to the armamentarium for bipolar disorder in later life is a welcome development, she said. Of the 6 million American adults with bipolar disorder, roughly 1 million are over the age of 60. Traditional mood stabilizers such as lithium often have limiting side effects in the older population, and treatment failures are common, she noted.

This pilot study was sponsored by NV Organon/Merck. Dr. Satajovic reported receiving research grants from Merck and other companies, as well as serving as a consultant to Prophase, Otsuka, Pfizer, Amgen, and United BioSource.

[email protected]