medwireNews: Optimal personalised treatment (OPT) improves quality of life and functioning of patients with bipolar disorder type I or II, suggests research published in the Journal of Affective Disorders.
However, adding low to moderate doses of lithium to OPT does not further improve patient outcomes, say Louisa Sylvia, from Massachusetts General Hospital in Boston, USA, and co-authors.
The Lithium treatment moderate-dose use study (LiTMUS) used the LIFE-Range of Impaired Functioning Tool (LIFE-RIFT) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) to monitor the patient perspective at baseline and 6 months after treatment.
In all, 283 symptomatic patients were randomly assigned to receive OPT, consisting of guideline-informed pharmacological treatment, adjusted on the basis of current symptoms, treatment history and bipolar course, with or without low to moderate doses of lithium.
At 6 months, patients in the OPT and OPT plus lithium treatment groups experienced significant and comparable improvements in both Q-LES-Q scores (9.4 vs 10.7) and LIFE-RIFT scores (2.3 vs 2.4).
And there was no significant correlation between lithium levels in the treated patients and change in quality of life or functional impairment.
In multivariate analysis, worse functioning at baseline was significantly associated with more children, lower income, greater severity of depressive symptoms and more comorbid psychiatric diagnoses.
“Our finding that having children is associated with lower life functioning [in] individuals with bipolar disorder may be because their children have a higher incidence of psychiatric disorders”, the researchers suggest.
“Thus, the responsibilities of parenting multiple children who might be psychiatrically compromised may be particularly complex for this population.”
Meanwhile, poor quality of life at baseline was noted for patients with lower income, more severe depressive symptoms, lower mania severity and higher suicidality.
At follow-up, patients experienced a trend towards less improvement in their functioning if they were younger at age of onset and less depressed at baseline, and less quality of life improvement if they were less depressed and more manic.
It is possible that patients with more severe depression at baseline came into the study with poorer quality of life and functioning and therefore had more improvements to make to reach the average attainments by week 24 of the study than less depressed individuals, the researchers observe.
The team concludes: “Given that specific clinical (i.e., symptoms, comorbidity, age of onset) and demographic (i.e., income, number of children) features predict life functioning and quality of life, further research is warranted on predictors of functioning and quality of life to enhance treatment and prevention strategies for bipolar disorder.”
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014
By Lynda Williams, Senior medwireNews Reporter