Trending Clinical Topic: Bipolar Disorder

Ryan Syrek

Disclosures

May 21, 2021

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From the role of calcium homeostasis to studies on emerging treatment options, increased discussion about bipolar disorder resulted in this week's top trending clinical topic. At a presentation during the virtual European Psychiatric Association (EPA) 2021 Congress, researchers discussed the role that calcium homeostasis may play in bipolar disease severity (see Infographic below). Investigators assessed 199 patients with type I (54.8%) or type II bipolar disorder. All were aged 18-65 years (mean age, 47.1 years), and none had comorbid neurologic disorders or substance abuse. After measuring serum parathyroid hormone (PTH), vitamin D, and calcium levels, investigators found that the number of hospitalizations and prior psychiatric episodes was significantly associated with PTH levels.

Strong correlations were also found between increased PTH levels and emotional neglect, emotional abuse, physical abuse, physical neglect, and total scores on the Childhood Trauma Questionnaire–Short Form. Serum vitamin D levels were positively associated with age at first psychiatric contact and were inversely correlated with total number of depressive episodes and a cyclothymic temperament. During the EPA 2021 Congress session, lead investigator Carmela Palummo said that "the results suggest that calcium imbalance may influence the long-term outcome of bipolar disorder." The findings also highlight the importance of routinely assessing PTH, vitamin D, and calcium levels in patients with bipolar disorder as a marker of clinical severity, Palummo added.

Recently, a separate study found that reduced heart rate variability (HRV) is associated with bipolar disease severity and may be viable as a biomarker. In a study that included 53 adult patients with bipolar I or II disease, investigators used the Illness Burden Index, a novel measure developed by the research team, to assess patients. Results showed that the greater the bipolar disease severity, the lower the HRV. Four main clinical variables for bipolar disorder were correlated with reduced HRV: illness duration, lifetime number of depressive episodes, duration of the most severe manic or hypomanic episode, and family history of suicide.

New research also found that blood-based biomarkers can distinguish between bipolar disorder and depression, and can also predict a person's future risk for those disorders and help tailor medication. The move toward precision psychiatry is bolstered by the study's results, which validated 26 candidate biomarkers for tracking mood states in independent cohorts of people with clinically severe depression or mania, and for predicting clinical course, including future hospitalizations for depression or mania. On the basis of this research, top drugs to emerge as potential new antidepressants are pindolol, ciprofibrate, pioglitazone, and adiphenine, as well as the natural compounds asiaticoside and chlorogenic acid, the researchers report.

Elsewhere, results of two phase 3, randomized, placebo-controlled trials show that an investigational, orally dissolving film formulation of dexmedetomidine may offer rapid relief from acute agitation related to bipolar disorder or schizophrenia. The findings, presented at the virtual American Psychiatric Association 2021 Annual Meeting, showed that the drug met the primary endpoint of reduction of agitation, as measured by the excited component of the Positive and Negative Syndrome Scale, for both conditions.

On the other hand, a recent study on the use of intermittent theta burst transcranial magnetic stimulation (iTBS) in patients with bipolar disorder reported that it was ineffective in alleviating symptoms. Overall, investigators found that only 16% of participants responded to iTBS during the double-blind period of the trial, and the proportion of patients who responded to iTBS was the same as the proportion who responded to sham treatment. Experts say that this highlights the need for further investigations into various foundational aspects for the therapy.

From biomarkers to therapies, a wide variety of new information about bipolar disorder led to the condition becoming this week's top trending clinical topic.

Read more clinical information about bipolar disorder.

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