Out Come of Bipolar I (Mania) Disorders, In Relation to Catatonic Symptoms.

The purpose of this study was to understand and probably explain the variability in symptomatology particularly with presence of catatonic symptoms and treatment response to lorazepam in mania. Methods: 52 patients of bipolar disorder were selected from admitted patients in psychiatry ward from P.B.H. Hospital, Bikaner. Structural Clinical Interview for DSM IV patient version (SCID-P) item Young Mania Rating Scale, 23 item Bush Francis Catatonia Screening Instrument and Rating Scale. 43 item Presumptive stressful Life Event Scale, were administered. Statistical tests were performed using SPSS version 9.0 were Pearson’s correlation Chi square analysis, test, ANOVA. Results: Only 3 patients out of 14 patients of first Manic episode showed good outcome. Patients with history of multiple episodes had shown better outcome (X2 = 11.59, df = 1, p < 0.00) The authors noted that the presence of catatonic symptoms (X2 = 17.76, df – 2, p < 0.001), high catatonic scores (F = 37.18, df = 2, 49, p < 0.000), and high reduction in catatonic score after Lorazepam challenge were associated with better outcome. There was strong negative correlation between index, catatonic and Mania Scores in grade I and grade II outcome category, (p < 0.000). Conclusions: This is a preliminary study to suggest that the presence of catatonic symptoms had better outcome in bipolar patients.

Outcome of Bipolar I (mania) disorders, In Relation with Personality Profile.

This prospective semi structured study evaluated the relations of symptomatology and outcome of bipolar manic patients with personality vulnerability. Methods: 52 patients of bipolar (mania) disorder, out of total 430 admitted patients in psychiatry ward, from January 10, to July 9, 2005 were included in the study. The patients with organic diseases or on any drugs for last two weeks were excluded from the study. All the patients were diagnosed as per ICD-10 diagnostic criteria. Patients of bipolar mania were administered Young Mania Rating Scale (YMRS) to assess the severity of mania. The personality traits and disorders were assessed by the help of ICD-10 module of International Personality Disorder Examination (IPDE). The stress in preceding one month was evaluated by using 41 items Presumptive Stressful Life Event Scale. Initial response to lorazepam was monitored to determine outcome categories. Results: The clinical and demographic variables of the study sample were analyzed with initial response to IV lorazepam as quick responder (grade-I), moderate and poor responders (grade II, III). Sociodemographic variables like marital status (x2 = 1.62, df = 2, NS) and education status (X2 = 4.57, df = 2, NS) did not approach to statistical significance in outcome. However, the outcome of the low income group patients was significantly better ( X2 = 16.84, df = 2, p < 0.001). Out of 14 (26.92%) patients of first manic episode, only 3 patients showed good response to initial lorazepam treatment (Grade I) and 9 and 2 patients assigned outcome category II and III respectively. Patients with history of multiple episodes had shown better response (X2=11.59, df=1, p<0.001, highly significant). Presence of stressful life events was positively correlated with better response to lorazepam treatment (x2==6.73, df=1, p<0.01 significant). Anxious (avoidant) or dependent traits alone or in combination with emotionally unstable personality traits in manic patients significantly determined better episode recovery with lorazepam at one hand proneness for relapses on the other hand.