Traumatic life events in bipolar disorder: impact on BDNF levels and psychopathology.

BACKGROUND: There is evidence that vulnerability to depression and anxiety disorders is markedly increased by traumatic life events. While childhood abuse has been reported to be associated with poorer outcomes in bipolar disorder, little is known about the neurobiological basis underlying this association. The aim of this study was to ascertain whether bipolar patients who were exposed to a traumatic event or events (TE) have lower brain-derived neurotrophic factor (BDNF) levels and more severe psychopathology as indicated by increased comorbidity and other clinical features when compared to those who were not exposed to TE. METHODS: One-hundred and sixty-three consecutively recruited bipolar outpatients were assessed by Structured Clinical Interview for DSM-IV (SCID) and standard protocol in order to evaluation psychopathology and clinical features. The reported TE was assessed using DSM-IV stem criteria for trauma (as defined by A1 and A2 criteria for trauma for post-traumatic stress disorder). Subjects were divided into 2 groups according to presence or absence of lifetime TE. The levels of BDNF, comorbidity and other clinical features were compared between groups. RESULTS: After adjusting for confounders, results indicated that bipolar patients with a history of TE have alcohol abuse/dependence (p < 0.001), anxiety comorbidity, and lower levels of serum BDNF (p < 0.01) compared to those without a history of TE. There was no difference between the 2 groups in age of onset, presence of psychosis, other substance abuse and dependence, rapid cycling or suicide attempts. CONCLUSIONS: Our findings suggest that TE are associated with significantly increased prevalence of alcohol and anxiety comorbidity as well as lower BDNF levels in bipolar patients. It is possible that a decrease in BDNF levels may account for increased comorbidity, but further prospective studies are required to confirm this.

Manic symptoms and quality of life in bipolar disorder.

This study evaluates the influence of manic symptoms on quality of life in a sample of adult bipolar disorder (BD) patients. This was a cross-sectional study including 125 BD outpatients from a university-based program. All patients were diagnosed using the Structured Clinical Interview for DSM-IV for BD. Manic symptoms and quality of life were assessed using the Young Mania Rating Scale (YMRS) and the World Health Organization Quality of Life Instrument-Short Version (WHOQOL-BREF), respectively. In the unadjusted analysis using linear regression, the score of manic symptoms was inversely associated with scores of quality of life within the social domain of the WHOQOL. In the adjusted analysis, the score of manic symptoms was inversely associated with the social, physical, and psychological domains of the WHOQOL. In a separate analysis at the YMRS items, items 4 (irritability) and 5 (sleep) were associated with lower quality of life.

Anxiety comorbidity and quality of life in bipolar disorder patients.

OBJECTIVE: To assess the impact of anxiety comorbidity on the quality of life of patients with bipolar disorder (BD). METHODS: We undertook a cross-Sectional survey of 162 BD outpatients interviewed with the Structured Clinical Interview for DSM-IV. The primary outcome measure was quality of life, assessed with the 26-item WHO Quality of Life Instrument (WHOQOL-BREF). RESULTS: Anxiety comorbidity in BD patients was associated with lower scores in all domains of quality of life. The impact of anxiety comorbidity on the psychological domain of the WHOQOL-BREF was kept, even when the current level of depression was added to the model as a confounding factor. Current anxiety comorbidity was also associated with lifetime alcohol abuse and dependence, rapid cycling, lifetime psychosis, number of suicide attempts, and a lower score in the Global Assessment of Functioning measure. CONCLUSION: Our findings suggest that anxiety comorbidity in BD patients is related to lower quality of life, particularly on the psychological domain. BD-anxiety comorbidity may be associated with such markers of illness severity as number of suicide attempts, rapid cycling, lifetime alcohol abuse, and psychosis. The recognition and treatment of anxiety comorbidity may help patients with BD to relieve their psychological pain and improve their overall quality of life.