Episode accumulation associated with hastened recurrence and delayed recovery in bipolar disorder

Park, Dong Yeon; Do, Dennis; Chang, Lauren; Shah, Saloni; Yuen, Laura D.; Hooshmand, Farnaz; Wang, Po; Miller, Shefali; Ketter, Terence A.

doi:10.1016/j.jad.2017.11.071

Cited by 11 publications

(9 citation statements)

References 74 publications

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“…For example a narrative review concluded that across studies, NoE is a reliable predictor of relapse in BD . More recently, within two longitudinal studies, NoE predicted risk of recurrence in the subsequent 2‐ or 4‐year periods . Similarly, a large naturalistic study reported an increased risk of relapse leading to hospitalization with each subsequent episode .…”

Section: Correlates Of Number Of Episodesmentioning

confidence: 76%

“…These differences remained after 12 months of evidence‐based pharmacological and psychological interventions. Subsequent analyses of the STEP‐BD sample showed that those who had experienced at least ten mood episodes were slower to recover from episodes and more likely to report symptoms of sadness, anhedonia, euphoria, irritability and anxiety between episodes . In an epidemiological study, NoE was associated with a higher number of current and lifetime psychiatric and medical comorbidities .…”

Section: Correlates Of Number Of Episodesmentioning

confidence: 99%

“…In an epidemiological study, NoE was associated with a higher number of current and lifetime psychiatric and medical comorbidities . Studies have also reported higher rates of suicidality and higher levels of perceived stigma for those with higher NoE …”

Section: Correlates Of Number Of Episodesmentioning

confidence: 99%

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Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement

2019

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Objectives Number of mood episodes (NoE) may be an important prognostic indicator in bipolar disorder, with implications for treatment. However, NoE has been conceptualized and measured inconsistently throughout the literature. This review examines the construct of NoE in bipolar disorder, with the aim of enhancing its conceptualization and measurement. Methods A critical evaluation of literatures on important correlates of NoE, conceptually and phenomenologically overlapping features, and previous studies considering and measuring this construct was undertaken. Results The literature indicates that despite frequent use, NoE has been inconsistently defined and measured. Multiple studies have linked NoE with important clinical factors, including relapse, functioning, cognitive impairment and the effectiveness of both pharmacological and psychosocial interventions, yet conclusions are limited by its inconsistent treatment. Additionally, it seems evident that that NoE may best be treated as a fuzzy construct (rather than precise figure), with yet to be defined overlaps with clinical variables such as age at onset and severity. Attempts to measure this construct have varied in comprehensiveness and structure. Conclusions The NoE construct may have important implications for individuals with bipolar disorders. However, more consistent and systematic definition and assessment of NoE is required to advance this literature and clarify its role. Recommendations aimed at advancing the conceptualization and the measurement of NoE are provided. Conceptualization may be advanced by considering and exploring relationships between NoE and factors with which it overlaps, while measurement may best be improved with increased consistency and balancing accuracy with feasibility.

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Section: Correlates Of Number Of Episodesmentioning

confidence: 76%

Section: Correlates Of Number Of Episodesmentioning

confidence: 99%

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Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement

2019

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“…Emphasizing the long-term outcomes as opposed to short term symptomatic treatment of bipolar disorder is vital because of its potential to be disease-modifying. Not only do mood episodes directly bring biological, psychological and psychosocial deleterious effects for patients, but also increase the vulnerability to new episodes (Park et al 2018). Many patients have a progressive course of disease, and there is a robust body of literature on neuroprogression and on staging bipolar disorder focused on impaired cognition and functioning (Robert M. Post, Fleming, and Kapczinski 2012).…”

Section: (Which Was Not Certified By Peer Review) Preprintmentioning

confidence: 99%

“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

Marchionatti

Rocha

Magalhaes

2021

Preprint

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BackgroundThe term “mood stabilizer” is controversial in literature. As there is no consensual meaning, its retirement has been suggested to avoid confusion and misuse. On the other hand, it remains largely employed, and some advocate it carries an important meaning. This issue has not been previously approached using a validated qualitative inquiry.MethodsWe employed document analysis for reviewing proposed definitions for mood stabilizer. Then, we used concept analysis as a qualitative methodology to clarify meanings associated with the term. Based on its results, we built a theoretical model for mood stabilizer, matching it with evidence for drugs used in the treatment of bipolar disorder.ResultsConcept analysis of documents defining the term unearthed four attributes of a mood stabilizer that could be usefully nested into the following ascending hierarchy: “not worsening”, “acute effects”, “prophylactic effects”, and “advanced effects”. To be considered a mood stabilizer, a drug had to reach the “prophylactic effects” tier, as this was discussed by authors as the core aspect of the class. After arranging drugs according to this scheme, “lithium” and “quetiapine” received the label, but only the former fulfilled all four attributes, as evidence indicates it has neuroprotective action.ConclusionThe proposed model uses a hierarchy of attributes that take into account the complexity of the term and help to determine whether a drug is a mood stabilizer. Prophylaxis is pivotal to the concept, whose utility lies in implying a drug able to truly treat bipolar disorder, as opposed to merely targeting symptoms. This could modify long-term outcomes and illness trajectory.

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“…Later stage cut-off for this review Number of mood episodes [15][16][17][18][19] >10 episodes 3,15,96,97 General or social functioning/ Disability 6,9,20,50 Established cut-offs or qualitative descriptors for later stage where cut-offs are unavailable (moderate to severe functional impairments):…”

Section: Proxy Variablesmentioning

confidence: 99%

The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review

et al. 2020

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Objectives The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non‐symptom) outcomes following psychosocial intervention. Methods A systematic literature search following PRISMA guidelines was conducted to identify empirical studies of psychosocial interventions for established BD. To investigate stage as a predictor of three functional outcomes (general/social functioning, cognitive functioning and quality of life [QoL]), study samples were dichotomised into earlier and later stage using proxy measures identified in existing staging models. Findings were integrated using data‐based convergent synthesis. Results A total of 88 analyses from 62 studies were identified. Synthesis across studies suggested that psychosocial intervention was more likely to be effective for general functioning outcomes earlier in the course of established BD. No stage‐related differences were found for cognitive or QoL outcomes. Exploratory investigations found some evidence of an interaction between specific intervention type and stage of illness in predicting outcomes. Conclusions A novel systematic review provided preliminary evidence that benefits general/social functioning may be more pronounced in earlier versus later stages of established BD. The review also generated hypotheses about a potential three‐way interaction, whereby specific psychosocial interventions may be best placed to target functional outcomes in earlier versus later stage BD. The strength of conclusions is limited by the overall low‐quality and significant heterogeneity of studies. Further research is urgently required to understand the impact of illness stage on the effectiveness of psychosocial interventions.

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Episode accumulation associated with hastened recurrence and delayed recovery in bipolar disorder

Cited by 11 publications

References 74 publications

Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement

Number of episodes in bipolar disorder: The case for more thoughtful conceptualization and measurement

“Addressing the core trait of bipolar disorder”: a concept analysis of mood stabilizing drugs

The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review

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