@article{ae11884d0b6443dfa7e618c2f2dd9171,
title = "Illness stage and predominant polarity in bipolar disorder: Correlation with burden of illness and moderation of treatment outcome",
abstract = "Bipolar disorder often follows a set progression best described in stages where advanced stages are associated with poorer outcomes. Bipolar disorder is also often characterized by a predominance of episode polarity, where some individuals experience more depressive episodes (termed predominant depressive polarity) while others experience more hypo/manic episodes (termed predominant hypo/manic polarity). We examined the associations between staging and predominant polarity with measures of illness burden and treatment outcome utilizing data from a six-month comparative effectiveness trial of lithium and quetiapine in bipolar disorder (Bipolar CHOICE). We used number of self-reported lifetime mood (depressive and hypo/manic) episodes as a proxy for staging and ratio of depressive to manic episodes to define predominant polarity. Polarity and staging were correlated with several measures of burden of illness. Childhood abuse was correlated with more lifetime mood episodes, while more depressive episodes and depressive polarity were correlated with more anxiety disorder comorbidity. Depressive polarity was also correlated with more past trials of psychotropics, particularly antidepressants. However, neither staging nor predominant polarity moderated the randomized treatment effect of lithium vs. quetiapine. Number of depressive episodes in the past year was identified as a potential predictor of overall worse treatment outcome, regardless of medication condition. In conclusion, though staging and predominant episode polarity correlated with several measures of illness burden, they were not associated with differential treatment outcomes. This could be because many of our patients presented for treatment at advanced stages of illness and further highlights the need for early intervention in bipolar disorder.",
keywords = "Bipolar disorder, Lithium, Predominant polarity, Quetiapine, Staging",
author = "Masoud Kamali and Samantha Pegg and Janos, {Jessica A.} and Bobo, {William V.} and Benjamin Brody and Keming Gao and Ketter, {Terence A.} and McElroy, {Susan L.} and McInnis, {Melvin G.} and Rabideau, {Dustin J.} and Reilly-Harrington, {Noreen A.} and Shelton, {Richard C.} and Sylvia, {Louisa G.} and Mauricio Tohen and Andrew Nierenberg",
note = "Funding Information: Dr. Kamali has received research grant support from Assurex Health , Janssen Pharmaceutica , and AFSP . Dr. Bobo has been supported by NIMH , NSF , the Myocarditis Foundation , and the Mayo Foundation for Medical Education and Research . Dr. Ketter has received: grant/research support from Agency for Healthcare Research and Quality , AstraZeneca Pharmaceuticals LP , Cephalon Inc . (now Teva Pharmaceuticals), Eli Lilly and Company , Pfizer, Inc. , Merck & Co., Inc. , and Sunovion Pharmaceuticals ; consultant/advisory board fees from Acadia Pharmaceuticals , Allergan, Inc. , Avanir Pharmaceuticals , Depotmed , Forest Pharmaceuticals , Genentech , Janssen Pharmaceuticals , Merck & Co., Inc ., ProPhase, Sunovion Pharmaceuticals , Teva Pharmaceuticals , Bristol-Myers Squibb Company and Cephalon, Inc ; lecture honoraria from Abbott Laboratories, Inc ., GlaxoSmithKline , Otsuka Pharmaceuticals, Pfizer, Inc ., and AstraZeneca Pharmaceuticals LP ; and royalties from American Psychiatric Publishing, Inc. Dr. McElroy has been a consultant to or member of the scientific advisory boards of F. Hoffmann-La Roche Ltd. Idorsia, Myriad, Novo Nordisk, Otsuka, Sipnose, Sunovion and Takeda. She has been a principal or co-investigator on studies sponsored by Brainsway , Idorsia , Janssen , Marriott Foundation , Myriad, National Institute of Mental Health , Novo Nordisk , Otsuka , Sunovion . She is also an inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patent's assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. Dr. McInnis has received consulting fees from Janssen and Otsuka Pharmaceuticals and research support from Janssen ; he acknowledges the support of the Prechter Bipolar Research Program and the Richard Tam Foundation . Dr. Reilly-Harrington has received royalties from New Harbinger and Oxford University Press and has served as a consultant for Guidepoint. Dr. Shelton has received grants from Acadia Pharmaceuticals , Allergan plc , Boehringer Ingelheim , INmuneBIO , Intracellular Therapies, Neurorx, Inc. , Novartis International AG , LivaNova plc, Myriad Genetics , Inc., and Otsuka Pharmaceuticals . He has served as a consultant for Acadia Pharmaceuticals, Allergan plc, Neurorx, Inc., Novartis International AG, Evecxia Therapeutics, and Seelos Therapeutics. Dr. Sylvia has served as a consultant for United Biosource Corporation, Clintara, Bracket, and Clinical Trials Network and Institute. She receives royalties from New Harbinger. She has received grant/research support from NIMH , PCORI , AFSP , and Takeda. Dr. Tohen is a former full-time employee at Lilly (1997–2008). He has been a consultant for AstraZeneca, Abbott, BMS, Lilly, GSK, J&J, Otsuka, Roche, Lundbeck, Elan, Alkermes, Allergan, Intracellular Therapies, Merck, Minerva, Neurocrine, Pamlab, Alexza, Forest, Teva, Sunovion, and Gedeon Richter. His spouse is a former employee at Lilly (1998–2013). Dr. Nierenberg has served on the Scientific Ad Board for Alkermes, Jazz Pharma, Sage Pharma, Otsuka, and Neuronetics. He has served as a consultant for Acadia Pharm, Esai, Myriad, Merck, Ginger, and Protogenics. He has received honoraria from Sunovion and Neurostar. Dr. Brody , Dr. Gao , Dr. Rabideau , Ms. Pegg , and Ms. Janos declare no conflict of interest. Funding Information: Dr. Kamali has received research grant support from Assurex Health, Janssen Pharmaceutica, and AFSP. Dr. Bobo has been supported by NIMH, NSF, the Myocarditis Foundation, and the Mayo Foundation for Medical Education and Research. Dr. Ketter has received: grant/research support from Agency for Healthcare Research and Quality, AstraZeneca Pharmaceuticals LP, Cephalon Inc. (now Teva Pharmaceuticals), Eli Lilly and Company, Pfizer, Inc., Merck & Co., Inc., and Sunovion Pharmaceuticals; consultant/advisory board fees from Acadia Pharmaceuticals, Allergan, Inc., Avanir Pharmaceuticals, Depotmed, Forest Pharmaceuticals, Genentech, Janssen Pharmaceuticals, Merck & Co., Inc., ProPhase, Sunovion Pharmaceuticals, Teva Pharmaceuticals, Bristol-Myers Squibb Company and Cephalon, Inc; lecture honoraria from Abbott Laboratories, Inc., GlaxoSmithKline, Otsuka Pharmaceuticals, Pfizer, Inc., and AstraZeneca Pharmaceuticals LP; and royalties from American Psychiatric Publishing, Inc. Dr. McElroy has been a consultant to or member of the scientific advisory boards of F. Hoffmann-La Roche Ltd. Idorsia, Myriad, Novo Nordisk, Otsuka, Sipnose, Sunovion and Takeda. She has been a principal or co-investigator on studies sponsored by Brainsway, Idorsia, Janssen, Marriott Foundation, Myriad, National Institute of Mental Health, Novo Nordisk, Otsuka, Sunovion. She is also an inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patent's assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. Dr. McInnis has received consulting fees from Janssen and Otsuka Pharmaceuticals and research support from Janssen; he acknowledges the support of the Prechter Bipolar Research Program and the Richard Tam Foundation. Dr. Reilly-Harrington has received royalties from New Harbinger and Oxford University Press and has served as a consultant for Guidepoint. Dr. Shelton has received grants from Acadia Pharmaceuticals, Allergan plc, Boehringer Ingelheim, INmuneBIO, Intracellular Therapies, Neurorx, Inc., Novartis International AG, LivaNova plc, Myriad Genetics, Inc., and Otsuka Pharmaceuticals. He has served as a consultant for Acadia Pharmaceuticals, Allergan plc, Neurorx, Inc., Novartis International AG, Evecxia Therapeutics, and Seelos Therapeutics. Dr. Sylvia has served as a consultant for United Biosource Corporation, Clintara, Bracket, and Clinical Trials Network and Institute. She receives royalties from New Harbinger. She has received grant/research support from NIMH, PCORI, AFSP, and Takeda. Dr. Tohen is a former full-time employee at Lilly (1997–2008). He has been a consultant for AstraZeneca, Abbott, BMS, Lilly, GSK, J&J, Otsuka, Roche, Lundbeck, Elan, Alkermes, Allergan, Intracellular Therapies, Merck, Minerva, Neurocrine, Pamlab, Alexza, Forest, Teva, Sunovion, and Gedeon Richter. His spouse is a former employee at Lilly (1998–2013). Dr. Nierenberg has served on the Scientific Ad Board for Alkermes, Jazz Pharma, Sage Pharma, Otsuka, and Neuronetics. He has served as a consultant for Acadia Pharm, Esai, Myriad, Merck, Ginger, and Protogenics. He has received honoraria from Sunovion and Neurostar. Dr. Brody, Dr. Gao, Dr. Rabideau, Ms. Pegg, and Ms. Janos declare no conflict of interest. Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",
year = "2021",
month = aug,
doi = "10.1016/j.jpsychires.2021.05.082",
language = "English (US)",
volume = "140",
pages = "205--213",
journal = "Journal of Psychiatric Research",
issn = "0022-3956",
publisher = "Elsevier Limited",
}