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Lithium is a cornerstone in treatment of bipolar disorder. Findings are conflicting as to whether acquired unresponsiveness occurs following the discontinuation. Retrospective life chart data were evaluated to investigate the incidence of loss of response. Sixty-five patients chosen from a larger cohort, followed with prospective life charts, who discontinued lithium and had a second lithium treatment. Patients who had at least 2 mood episodes when they were drug naïve to describe the natural frequency of illness and 3 mood episodes before the discontinuation were included. The type of response was defined as excellent, partial, or poor according to mirror design method. Eighteen of 65 patients (27.6%) had a decreased response to lithium following its discontinuation. Nine of these patients (13.8%) were unresponsive and nine patients (13.8%) had attenuated response to second lithium treatment. The mean time of discontinuation was longer in the patients who show decreased response (245.8+268.2 vs. 117.9+149.8 days, p=.01). Those who had episode recurrences during the discontinuation were more likely to show reduced responsiveness upon re-treatment. After discontinuation of lithium treatment, more than a quarter of the patients showed an attenuated response or unresponsiveness, and initial partial responders more likely to show unresponsiveness than excellent responders., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The aim of the present study was to investigate the potential influence of childhood trauma on clinical presentation, psychiatric comorbidity, and long-term treatment outcome of bipolar disorder. A total of 135 consecutive patients with bipolar disorder type I were recruited from an ongoing prospective follow-up project. The Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM-IV Axis I Disorders were administered to all participants. Response to long-term treatment was determined from the records of life charts of the prospective follow-up project. There were no significant differences in childhood trauma scores between groups with good and poor responses to long-term lithium treatment. Poor responders to long-term anticonvulsant treatment, however, had elevated emotional and physical abuse scores. Lifetime diagnosis of posttraumatic stress disorder (PTSD) was associated with poor response to lithium treatment and antidepressant use but not with response to treatment with anticonvulsants. Total childhood trauma scores were related to the total number of lifetime comorbid psychiatric disorders, antidepressant use, and the presence of psychotic features. There were significant correlations between all types of childhood abuse and the total number of lifetime comorbid psychiatric diagnoses. Whereas physical neglect was related to the mean severity of the mood episodes and psychotic features, emotional neglect was related to suicide attempts. A history of childhood trauma or PTSD may be a poor prognostic factor in the long-term treatment of bipolar disorder. Whereas abusive experiences in childhood seem to lead to nosological fragmentation (comorbidity), childhood neglect tends to contribute to the severity of the mood episodes.

This research was conducted as an controlled experimental study which aimed to determine the effectiveness of individual psychoeducation program on recurrence rate during 1year follow up period. The study included eighty-two patients who had been diagnosed with bipolar disorder. There were no hospitalizations in intervention group, while 7.3% of control patients experienced hospitalizations; recurrence rates were 18.9% in the intervention group patients and 34.1% in the control group patients, but statistical significant difference between the groups was not found. Four sessions of individual psychoeducation may have some positive effects but seem to be ineffective for preventing recurrences in patients with bipolar disorder during one year prospective follow up., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Aim of this systematic review was critical presentation of psychosocial approaches in bipolar disorders with regard to their fundamentals and impact on the clinical course and outcome of the illness., Method: PubMed, Medline, PsycINFO and Turkish databases between 1980 and 2009 were searched by using keywords "bipolar disorder" and "psychotherapy", "psychosocial approaches", "psychological intervention". Randomized controlled trials, reviews and meta analysis were included., Results: Fifty studies met the inclusion criteria where four types of interventions -psychoeducation, family focused, cognitive behavioral and interpersonal psychosocial rhythm therapy-were studied. Twenty two of 24 original research papers were randomized controlled trials, 23 were reviews and 3 were meta analysis. In almost all studies psychotherapeutic approach was applied as adjunctive to pharmacotherapy. Group psychoeducation was more effective in preventing manic relapses, whereas cognitive behavioral and family focused therapies showed efficacy in preventing depressive episodes. Additional benefits on such secondary outcomes as medication compliance, number and duration of hospitalizations, time to recurrence were reported. Effects on functionality and quality of life were assessed rarely, but reported to be beneficial. Cultural adaptation studies are scarce and needs exploration., Conclusion: Psychosocial interventions adjunctive to pharmacotherapy in bipolar disorder seem to be effective in relapse prevention. Stage of illness where the therapy is initiated and the targeted episode for prevention varies between interventions. Future studies are needed to strengthen the place of psychosocial interventions in treatment guidelines and would contribute to narrow the gap between effectiveness of pharmacotherapy and functional improvement.

Objective: In this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features., Method: The life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups., Results: The psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p=0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p=0.013). Episodes were more severe (p<0.001) and hospitalization rates were higher (p=0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p<0.001)., Conclusion: The well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Objectives: The goal of this paper was to determine factors which are related to motivation of bipolar patients to attend a psychoeducation program., Methods: Patients with bipolar disorder which had at least four years of prospective follow-ups were invited to a 6-week psychoeducation program. Patients who accepted and those who refused the participation were compared using several clinical characteristics., Results: Of the 173 patients who were invited, 84 participated in the program. Participants had significantly more family history of bipolar disorder and suicide, good response to prophylactic treatment, full medication adherence, therapeutic blood levels of mood stabilizers, regular follow-up visits, mixed episodes, and significantly less total number of episodes. Presence of mixed episodes, full medication adherence and therapeutic blood level of mood stabilizers were found predictive for attendance in logistic regression analysis., Conclusions: Our results suggest motivation and participation rates of patients who attended a psychoeducation program were constrained. Factors associated with a poor response to psychopharmacologic treatments also seem valid for non-attendance to the psychological interventions.

Background: Although bipolar disorder and schizophrenia have long been viewed as distinct illnesses, there is growing evidence that these two complex diseases share some common genes, which may manifest as overlapping neuropsychological impairments. Although working memory dysfunction has been proposed to be central to the pathophysiology of schizophrenia, it has received less attention in studies of bipolar disorder., Method: We applied measures of working memory to patients with schizophrenia (n = 15), patients with schizoaffective disorder (n = 15), patients with psychotic (n = 11) and non-psychotic (n = 15) bipolar disorder, and demographically matched healthy subjects (n = 32), in order to determine the extent to which these groups show common or unique impairments., Results: While patients with bipolar disorder (with and without psychotic features) and those with schizophrenia/schizoaffective disorder were impaired on backward digit span, only patients with a lifetime history of psychotic features, regardless of diagnosis, were impaired on spatial delayed response task., Conclusions: Backward digit span performance is comparable in bipolar disorder and schizophrenia, and may be an appropriate endophenotypic marker that cuts across diagnostic categories. In contrast, spatial working memory performance clearly distinguishes non-psychotic bipolar disorder patients from patients with functional psychosis.

The recurrent nature of bipolar disorder needs an optimum compliance with long term pharmacotherapy, however the poor adherence is common. Adjunctive psychoeducation seems favorable effects on adherence during the long term pharmacotherapy. Even strong benefits were showed, setting a psychoeducation in clinical practice is still novel and recruiting the patients with long history of bipolar disorder may not be feasible. In literature, recruitment rate, motivation and attitudes of patients for participation in psychoeducation is not studied. The present study was conducted to clarify the intends of patients with bipolar disorder to participate in psychoeducation and the factors that contribute. The euthymic patients with diagnosis of bipolar disorder I or II, were invited to the 6 week psychoeducation program in prospective study. The demographic and clinical data were obtained from life charts and updated with a clinical interview. The blood levels of mood stabilizers, adherence, response to prophylactic treatment, relapses and hospitalization rates between the participants and non-participants were compared. 84 patients were attended the program, 71 patients were considered as unwilling to attend. The motivation of patients to attend a psychoeducation is limited. The participation rate was only 54.2%. The patients who refused attending to this program have fewer adherences to medication and irregular follow up visits, insufficient blood levels of mood stabilizers, poor response to long term treatment, more likely have mood episodes. Education level between attendees and non-attendees were not different. Optimum methods are required for recruitment of bipolar patients to a psychoeducation program. [Copyright &y& Elsevier]