Sleep impairment and co-morbidity in bipolar disorder

neurobiologia.org

Comparative study between the perception of quality of sleep and quality of life, depressive and anxiety symptoms in euthymic bipolar disorder Comparative study between the perception of quality of sleep and quality of life, depressive and anxiety symptoms in euthymic bipolar disorder Estudo comparativo entre percepção da qualidade de sono, qualidade de vida, sintomas depressivos e ansiosos em transtorno bipolar fase eutímica Estudo comparativo entre percepção da qualidade de sono, qualidade de vida, sintomas depressivos e ansiosos em transtorno bipolar fase eutímica ABSTRACT INTRODUCTION: The bipolar disorder is characterized by alternating and recurrent episodes of mania and hypomania with depression and periods of euthymia, with prevalence between 1 and 8% in the general population. The mental disorders influence the quality of life considerably, disturbing familiar, social and occupational relations. Sleep is also associated with the quality of life; moreover, it can be modified in bipolar disorder. OBJECTIVES: To assess the perception of the quality of sleep, the quality of life and evaluate the intensity of depressive and anxiety symptoms in euthymic bipolar disorder when compared with a controlgroup. To investigate possible association of depressive and anxiety symptoms in quality of life and quality of sleep. METHODS: The design of research was case-control and the sample was characterized as a noprobability for convenience. Study-group (n=43) and control-group (n=80). The selection for the study-group had the following criteria: patients with bipolar disorder in the stabilized phase, age between 25 and 60, in use of stabilizer of mood and absence of psychiatric co-morbidity. Instruments: Pittsburgh Sleep Quality Index,

https://www.ijrrjournal.com/IJRR_Vol.6_Issue.12_Dec2019/Abstract_IJRR0029.html, 2019

Background and Aim: Many studies have explored prevalence of psychiatric comorbidity in bipolar affective disorder. However, Indian studies are lacking in this area. The present study was aimed to assess prevalence of psychiatric comorbidity in bipolar affective disorder patients. Material and Methods: 100 randomly selected patients with bipolar affective disorder as per ICD-10 criteria were cross-sectionally assessed. After taking written informed consent and recording socio-demographic details, Young’s Mania Rating Scale, Hamilton Rating Scale for Depression, Mini International Neuropsychiatric Interview, Global Assessment Scale and Brief Psychiatric Rating Scale were applied. Appropriate statistical methods were used. Results: Out of 100 patients, majority were males (71%), belongs to 21-30 years (36%) and 31-40 years (23%) age group, under matric (59%), married (66%). Majority of patients were unemployed (53%) and belonged (75%) to nuclear family, from rural areas (58%). A significantly higher number of male patients were found in both groups ( 87.87% & 62.68% respectively(x2 7.04, p < 0.05), had a family income of rupees 5001-1000093.94.% & and 33.33% respectively (x27.08, p <0.05 S),history of suicide attempts 27.27% & 10.45% respectively (x2 4.45, p < 0.05 S). A significantly higher number of patients with comorbidity than without comorbidity, had more than two admissions 21.21% & 5.97% respectively (x2 4.95, p < 0.05 S),treated in ward cases 45.45% & 23.88% respectively (x2 4.73, p < 0.05 S). Majority of patients belong to Other harmful use/dependence group (54.55%) and 24.24% to Anxiety disorder. Remaining 15.15% and 6.06% belong to Alcohol harmful use/dependence and Personality disorder respectively. Conclusion: Approximately 1/3rd patients with bipolar disorder have psychiatric comorbidity, most common being substance use & dependence followed by anxiety disorders. Comorbidity in bipolar disorder worsens the prognosis and future course of illness. Management of comorbidity along with the primary disorder should be an integral part of management of patients with bipolar affective disorder.

Scholarly Journal of Psychology and Behavioral Sciences

The two most common bipolar disorders are bipolar I disorder and bipolar II disorder. Comorbid psychiatric disorders usually precede the onset of bipolar disorder. Bipolar disorder often coexists with other Axis I and Axis II disorders. Studies have shown that patients with mood disorders have more comorbid medical illnesses. Research has suggested that that there may be underlying biological mechanisms linking mood disorder and many medical illnesses.The current study will determine the psychiatric and medical disorders in a sample of patients with bipolar affective disorder in a general hospital setting. Aims and Objectivest: study the socio-demographic profile of patients with Bipolar affective disorder, to study the prevalence of psychiatric comorbidities in patients with Bipolar affective disorder and to study the prevalence of medical comorbidities in patients with Bipolar affective disorder.

Clinical practice and epidemiology in mental health : CP & EMH, 2005

Data from surveys of large samples showed the lifetime prevalence rates of bipolar disorder around 1.5%. A main question is whether the low prevalence rates of bipolar disorders are not an artefact of the over-diagnosis of depression and under-diagnosis of bipolar-II.Analysis of the clinician&#39;s logical inferential diagnostic process, confirms that the patient does not represent the sole source of useful information because many patients do not experience hypomania as distress but rather as recovery from depression or as a period during which they felt truly well.Epidemiological data are derived from interviews carried out by lay staff which only reflect the patient&#39;s point of view.The clinical monitoring study carried out alongside the ESEMED project found for the diagnosis of mood disorders, a Kappa agreement (versus clinical interview) which ranged from 0.23 in Spain to 0.49 in France.If we consider exactly what a Kappa of 0.4 implies for a disorder with an &quot;identifie...

Clinical Psychology and Psychotherapy, 2020

Sleep problems are highly prevalent in bipolar disorder (BD) and constitute an important therapeutic focus in this population: They are highly impairing and distressing, are an area of subjective importance to consumers, and likely play a role in predicting/triggering mood episodes. The aim of this review is to orient psychologists and psychotherapists to current research relevant to their clinical practice with people with BD, including (a) the prevalence and presentation of sleep problems, (b) the impacts and correlates of impaired sleep, and (c) the relationship between sleep problems and mood symptoms (including the predictive/triggering role of sleep in BD mood relapses). Detailed recommendations for assessment and cognitive–behavioural intervention strategies for use in BD are described. It will be concluded that although some sleep problems and comorbidities require interdisciplinary collaboration, a range of evidence-informed strategies can be effectively and appropriately applied by clinical psychologists and psychotherapists.

IP innovative publication pvt. ltd, 2019

Aim: Recurrent episodes of depression are common in both unipolar and bipolar disorder, but diagnostic and clinical problem with bipolar mood disorder is that hypomanic episodes usually go unnoticed by caretakers and clinicians. Several studies have indicated that if carefully looked for, 25% of patients with major depressive disorder have history of bipolarity. So we aim to assess the proportion of patients with features of bipolar disorder amongst those primarily diagnosed and treated as major depressive disorder and compare the symptom profile of unipolar depression and bipolar depression. Methodology: One hundred consecutive patients, in tertiary care hospital in Ahmadabad, who were being treated as major depressive disorder according to DSM-4 TR and assessed using scales, HAM-D, GAF, Hypomania Check List-32(HCL) and Mood Disorder Questionnaire (MDQ). Patients who scored higher in HCL and MDQ were assessed in details by MINI. Results: 100 patients of unipolar depression were taken in study, out of which 16 patients were found to have bipolar mood disorder after assessment. Our incidence of bipolar mood disorder in patients treated as unipolar depression is 16%. Patients of bipolar depression had significantly higher number of prior mood episodes, family history of mood disorder and episodes with psychotic features. Conclusion -Bipolarity is confidently diagnosable in a substantial proportion of patients being treated as unipolar major depression. All the patients of unipolar depression must be screened for bipolarity to give them specific treatment with better results and better quality of life.

Journal of Psychiatric Practice, 2015

Background and Goals: Sleep disturbances have been noted not only during affective episodes in bipolar disorder, but also between affective episodes. The goal of this study was to assess and identify determinants of sleep quality in patients with bipolar I disorder. Methods: This cross-sectional study enrolled patients with bipolar disorder who were currently in remission. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Mood symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (Ham-D). Adherence was assessed using the Medication Adherence Rating Scale. Results: The mean age in the sample (N=103) was 37.4 years; 44.7% of the sample were men. On the basis of PSQI scores, 41 patients (39.8%) were poor sleepers. Poor sleepers had significantly higher Ham-D scores (mean score of 1.8 vs. 0.9, P=0.012) and higher rates of medication nonadherence (36.6% vs. 11.3%, P=0.002). The relationship between Ham-D scores and sleep quality did not remain significant when the sleep-related items on the Ham-D were removed. Logistic regression analysis suggested that medication nonadherence was the only independent predictor of poor sleep quality in this study. Conclusions: A significant proportion of patients with bipolar disorder who are in remission have sleep problems that seem to be independent of core symptoms of depression.

ABSTRACT INTRODUCTION: Bipolar disorder patients (BP) with comorbid Substance Use Disorder (SUD) may present clinical features that could compromise adherence and response to pharmacological treatment. The purpose of this study was to examine clinical and psychopathological features of BP with and without comorbid SUD in a real-world setting. METHODS: The sample was composed by 131 affective patients. Sixty-five patients were affected by Bipolar Disorder I (BP-I, 49.2%), 29 by Bipolar Disorder II (BP-II, 22.3%) and 37 by Cyclothymic Disorder (CtD, 28.5%), according to DSM-IV. Sixty-six patients were diagnosed for a comorbid SUD. All patients have been submitted to psychometric assessment with Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Young Mania Rating Scale (YMRS), Global Assessment Scale (GAS), Social Adjustment Self-reported Scale (SASS), Quality of Life Scale (QoL), at baseline and repeated follow-up periods (1, 3, 6, 12 months). RESULTS: BP comorbid for SUD were more likely diagnosed as BP-II and CtD and were less likely to present a moderate-severe manic symptomatology. Furthermore, personality disorders were more frequent in SUD patients than in non-comorbid BP. BP with SUD were not different for primary outcome measure (HDRS, HARS, YMRS, GAS) from non-comorbid BP; however, BP with SUD were significantly more impaired in social functioning (SASS) at any stage of the follow-up and poor functioning increased the risk of relapse in substance use during treatment. Finally, SUD comorbidity did not represent a risk factor for treatment drop-out, while in our sample young age, low treatment dosage and BP-I diagnosis were significantly associated with drop-out. DISCUSSION: The primary finding of this work is that BP with comorbid SUD are significantly more compromised in social functioning. Second, these patients were less likely to be diagnosed for BP-I and to present a severe manic symptomatology. Finally, we found that the diagnosis of SUD, but young age, low treatment dosage and BP-I diagnosis to be risk factors for treatment drop-out. Physicians should be alert to these differences in their clinical practice.

Indian Journal of Psychological Medicine, 2017

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