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09-12-2009 | Mental health | Article

Bipolar II disorder treatment in specialized clinics may be ‘suboptimal’

Abstract

Free abstract

MedWire News: The overall outcome of bipolar disorder patients is improved by treatment in a specialized bipolar clinic, but the treatment of bipolar II disorder appears to be suboptimal, the results of a European study indicate.

Due to beliefs over the apparent “soft” nature of bipolar II disorder, despite patients being symptomatic for longer and having more chronicity and comorbidity than those with bipolar I disorder, the condition may be undertreated, with a risk for a more recurrent course.

To investigate the course of bipolar disorder further, Benedikt Amann, from Complex Assistencial en Salut Mental in Barcelona, Spain, and colleagues studied 18 bipolar II disorder and 31 bipolar I disorder patients. The patients were assessed monthly for an average of 26 months using the life-chart methodology–clinician version, the Young Mania Rating Scale, the Inventory of Depressive Symptoms, the Clinical Global Impression – Bipolar Version, and the Global Assessment of Functioning.

Dividing follow-up into three terms – first year, third to fifth half year, and sixth to eighth half year – the team found that the increase in euthymic days in the second versus the third term was significant, but the difference between the second and third terms was not significant. A similar pattern was seen for depressive and manic days.

In each 6-month interval, both bipolar I and II disorder patients had more days marked as (sub)depressive than (hypo)manic, aside from in the last three intervals, during which bipolar II patients had more hypomanic days than bipolar I disorder patients.

While both bipolar I and II patients had reductions in the number of high–moderate to severe depressive days between the first and eighth half years, the number of high–moderate to severe manic days increased slightly by 2.0% in bipolar I disorder patients from the first to the second term and then decreased slightly by 1.9% until the end of follow-up. Similar findings were observed for hypomanic days.

Interestingly, the percentage of days on anticonvulsants increased during follow-up for bipolar I disorder patients but decreased in bipolar II disorder patients, with the opposite pattern seen for antidepressant use. Bipolar I disorder patients were also prescribed significantly more mood stabilizers than bipolar II disorder patients.

The team concludes in the journal Acta Psychiatrica Scandinavica: “Bipolar II disorder seems to be correlated with a worse course as regards to depressive episodes and a more difficult-to-treat course of the illness.

“Our results suggest pronounced differences in terms of an increase of euthymic days between bipolar I and bipolar II favoring bipolar I disorder after therapy.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Liam Davenport

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