Correlates of current suicide risk among Thai patients with bipolar I disorder: findings from the Thai Bipolar Disorder Registry.

BACKGROUND: The Thai Bipolar Disorder Registry was a prospective, multisite, naturalistic study conducted in 24 hospitals across Thailand. This study aimed to examine the correlates of current suicide risk in Thai patients with bipolar I disorder. METHODS: Participants were adult inpatients or outpatients with bipolar disorder, based on the Diagnosis and Statistical Manual of Mental Disorders, fourth edition. All were assessed by using the Mini International Neuropsychiatric Interview (MINI), version 5. The severity of current suicide risk was determined by using the total score of the MINI suicidality module. Mood symptoms were assessed by using the Young Mania Rating Scale and the Montgomery Asberg Depression Rating Scale. RESULTS: The data of 383 bipolar I disorder patients were included in the analyses. Of these, 363 (94.8%) were outpatients. The mean (standard deviation) of the MINI suicide risk score was 1.88 (5.0). The demographic/clinical variables significantly associated with the MINI suicide risk scores included age, number of overall previous episodes, the Young Mania Rating Scale score, the Montgomery Asberg Depression Rating Scale scores, and the Clinical Global Impression Severity of Illness Scale for Bipolar Disorder mania score, depression score, and overall score. The variables affecting the differences of suicide risk scores between or among groups were type of first mood episode, a history of rapid cycling, anxiety disorders, and alcohol use disorders. The stepwise multiple linear regression model revealed that the Montgomery Asberg Depression Rating Scale score (ß=0.10), a history of rapid cycling (ß=6.63), anxiety disorders (ß=2.16), and alcohol use disorders (ß=2.65) were significantly correlated with the suicide risk score (all P<0.01). CONCLUSION: A history of rapid cycling, severity of depressive episode, current anxiety disorders, and current alcohol use disorders correlate with current suicide risk among Thai bipolar I disorder patients. Further studies in larger sample sizes are warranted.

Interpersonal problems among psychiatric outpatients and non-clinical samples.

INTRODUCTION: The aims of this study were two-fold; to investigate the validity and reliability of the Thai version of the Inventory of Interpersonal Problems (IIP) and to compare the characteristics of the interpersonal problems experienced in a non-clinical sample and psychiatric outpatients. METHODS: A total of 689 subjects (452 non-clinical sample and 237 psychiatric outpatients) completed the IIP-32 and IIP-64, Symptom checklist-90 (SCL-90) and 16 Personality Factor (16 PF) Questionnaire, after which a four-week retest was carried out. Cronbach's alpha was used for internal consistency and the intra-class correlation coefficient was used to determine test-retest reliability. Factor analysis of the IIP sub-scales and Pearson's correlation were used for construct and concurrent validity. RESULTS: Both versions of the IIP showed good internal consistency. Factor analysis revealed two factors that corresponded to the circumplex property. The expected correlation between the SCL-90 and 16 PF subscales reflected the level of concurrent validity. There was a significant difference in the cold, socially-inhibited and self-sacrificing subscales between the non-clinical and clinical samples, while major depressive disorder was found to have a significantly higher score in the subscales of the control dimension, i.e. the non-assertive, socially inhibited and self-sacrificing subscales, than the neurotic and non-clinical groups, whereas, the neurotic group differed from the normative sample in terms of the affiliation axis. CONCLUSION: The IIP-64 and IIP-32 demonstrated their reliability and are suitable for use in either clinical or non-clinical setting.

Oxcarbazepine in the treatment of bipolar disorder: a review.

OBJECTIVE: To review the data on the efficacy of oxcarbazepine (OXC) in bipolar disorder (BD) and to provide recommendations for clinicians on the use of this medication in treating BD. METHOD: Using the terms oxcarbazepine and bipolar disorder, oxcarbazepine and mania, or oxcarbazepine and bipolar depression, we conducted a computer-aided search of MEDLINE for the years 1950 to 2005. RESULTS: Case reports, retrospective chart reviews, open prospective studies, and double-blind studies reported the efficacy and effectiveness of OXC in treating BD. The data indicate that OXC has efficacy in treating acute mania and may be a useful add-on in treating acute bipolar depression and in BD prophylaxis. OXC is generally well-tolerated. CONCLUSION: We recommend using OXC as monotherapy or as add-on therapy in refractory mania, but we recommend it be used predominantly as an add-on treatment for other phases of BD in patients who have not improved with well-established treatments or in patients who have difficulty tolerating adequate dosages.

Oxcarbazepine add-on in the treatment of refractory bipolar disorder.

OBJECTIVE: To assess the effectiveness and safety of oxcarbazepine (OXC) in bipolar disorder (BD) and related conditions. METHODS: We reviewed medical records of patients given OXC treatment between March 2003 and March 2005 at the University of British Columbia Hospital. Response to treatment was assessed retrospectively using the Clinical Global Impression of Severity (CGI-S), and the Clinical Global Impression of Improvement (CGI-I) scales. RESULTS: OXC was prescribed to 15 patients with bipolar I (n = 12), bipolar II (n = 2) and schizoaffective (n = 1) disorder who presented with depression (n = 9), mania (n = 3), hypomania (n = 1), or mixed state (n = 2). Six patients had Axis II diagnoses and 10 patients had a family history of mood disorders. Psychiatric co-morbidity was found in four patients. The mean daily dose of OXC was 775 +/- 556.11 mg/day and the mean duration of follow-up was 31.60 +/- 41.51 weeks. The OXC add-on led to a significant reduction in symptoms as indicated by reduction in CGI-S scores at 1 and 2 months. Nine of 12 patients at 1 month and seven of 14 at 1 or 2 months were much or very much improved on CGI-I scale. One patient (7%) developed hyponatremia. Six patients (40%) experienced no side effects and three patients (20%) stopped the medication because of side effects. CONCLUSION: OXC was effective and well-tolerated in refractory BD and schizoaffective disorder. These preliminary data are promising but controlled studies are needed to confirm its efficacy in refractory BD.