Long-term treatment response to continuous cycling course in bipolar disorders: A meta-analysis

OBJECTIVE

About 30% of patients with bipolar disorders (BD) exhibit a continuous cycling course (CCC). These patients significantly differ from those with non-continuous cycling course (NCCC) on clinical presentation and have a poorer short-term response to antidepressant treatment. Our aim is to conduct a meta-analysis of the studies comparing long-term treatment response in CCC and NCCC bipolar patients.

METHOD

We conducted a systematic review of studies on patients with a diagnosis of bipolar disorder with CCC. Our primary outcome measure was the response to treatment at the last follow-up visit. The data analysis was based on the success rate difference as the effect size measure. To account for heterogeneity of primary studies, aggregation of results was based on a random-effects model.

RESULTS

We included six observational studies comprising a total of 671 patients (CCC 29.4%, NCCC 70.6%). Overall, the response rate was 34.0% in the CCC and 49.3% in the NCCC arm. The meta-analysis shows a significant association between cycle pattern and response (success rate difference: -0.17; 95% CI: -0.25, -0.09; p < 0.0001), with low heterogeneity (χ² (5 )= 5.16; I² = 3%).

CONCLUSION

In bipolar disorders, patients with CCC have a poorer response to prophylactic treatment compared with patients with NCCC.

Patterns of Adaptation and School Performance: A Pilot Study

A group of 34 pupils from two school classes (Class 8, M=13.1 yr., SD = 0.5) were administered the Serial Color-Word Test to assess the pattern of adaptation during repeated exposure to the Stroop task (5 massed trials). The typological classification, centered on measures of linear (R) and nonlinear (V) change of reading times, employed norms derived from the medians of the group. The Stabilized primary pattern (low R and low V) corresponded to higher grades, compared with the other 3 primary patterns. Concerning the secondary classification across trials (based on the R and V of the 5 Rs, and on the R and V of the 5 Vs), better school performance was found among subjects with a linear increase of linear changes across trials (high R of the 5 Rs; CR pattern), compared with subjects with a nonlinear increase of linear changes (high V of the 5 Rs; DR and CDR patterns).

[Pharmacotherapy plus psychotherapy in patients with mood disorder and Axis II codiagnosis. A review]

AIM

The main aim of this paper is to review data on the efficacy of combined therapy in patients with mood disorder and axis II codiagnosis. The secondary aim is to assess the impact of personality disorders, psychotherapies, and combination therapy approaches on the treatment outcome.

MATERIALS AND METHODS

We searched the Medline database using the following syntax: "major depressive disorder", "bipolar depression", "personality disorder", "comorbidity", "epidemiology", "combined therapy", "sequential therapy". The search included studies published up to february 2011. We divided the selected studies on the basis of the following pharmacotherapy and psychotherapy combination treatment approaches: concurrent treatment, sequential treatment and cross-over treatment.

RESULTS

We found six studies about this topic. They show that in patients with unipolar depression combined therapy does not increase significantly the remission rate of the acute phases. However, combined treatment has greater effects on social functioning, interpersonal sensitivity and aggressiveness than pharmacological treatment. The studies indicate also that in patients with either unipolar or bipolar disorder combined therapy is more effective than pharmacological therapy in reducing relapses.

DISCUSSION

The available limited data suggest that in patients with mood disorder and axis II codiagnosis pharmacological and psychological combined therapy is useful. In these patients the type of combination approach does not seem to influence the treatment outcome.

Treating bipolar depression - antidepressants and alternatives: a critical review of the literature

OBJECTIVE

Although depressive symptoms are preponderant in the course of bipolar (BP) disorders, the treatment of BP depression remains a controversial issue with different clinical approaches available. This review addresses the issues of whether antidepressants (ADs) are effective in treating acute and long-term BP depression, risks linked to ADs and what alternatives to ADs are available.

METHODS

We searched the MEDLINE databases using the following syntax: [bipolar depression AND unipolar depression AND (antidepressants OR anticonvulsants OR lithium OR antipsychotics OR dopamine-agonists OR psychoeducation OR psychotherapy OR electroconvulsive therapy OR transcranial magnetic stimulation)]. The search included studies published up to 31 May 2009 and conducted on adults.

RESULTS

In the acute treatment of BP depression ADs are effective with no differences among drug classes. However, neither the switch into (hypo)mania induction rate nor the suicide risk linked to AD use are definitely established. The effectiveness of long-term AD use is limited to highly selected samples of patients with positive acute response. The risk of long-term ADs causing cycle acceleration and rapid cycling induction concerns a subpopulation of patients. Valid alternatives to ADs in treating acute BP depression are quetiapine, an olanzapine-fluoxetine combination, and electroconvulsive therapy for more severe patients. Lamotrigine is effective and safe in preventing depressive relapses. Psychotherapy and psychoeducation represent effective adjunctive treatments.

CONCLUSION

In the treatment of BP depression there is not a specific effective treatment for all the patients. Interventions should therefore be personalised and the scientific evidence should be adapted to each patient's clinical features.

The Great Ape Project: Premises and Implications

Is it consistent to accept ethical constraints on scientific research when humans are involved, and to reject them when it comes to non-humans? Is the current scientific practice of experimenting on sentient animals a “necessary evil” which must simply be tolerated, or is it an indefensible practice stemming from arbitrary discrimination based on species? These are some of the questions we address in this paper, in order to illustrate the implications for scientific experimentation of the first attempt to grant to some non-human beings the basic rights which have so far been limited to members of our own species. Resulting from the recent rethinking on the moral status of animals, this attempt revolves around the collective argument for the enfranchisement of chimpanzees, gorillas and orang-utans that, together with a distinguished group of scientists and philosophers, we have presented in The Great Ape Project. We draw from this volume some of the evidence that ethologists, language researchers, psychologists and anthropologists have gathered in favour of the attribution to the other great apes of many of the characteristics we traditionally consider to be morally significant when we find them in ourselves. After stressing the relevance of a species-neutral notion of person in the actual philosophical debate, we highlight the overwhelming case for its application, in both the moral and the legal senses, to the other great apes. While, on a general level, this would lead to the inclusion of our closest living relatives in the sphere of equality, as far as the practice of experimentation is concerned, it would result in extending to them those very restrictions which at present apply to scientific research on humans.