September, 2007. In my editorial in the Journal 1 year ago,1 I focused on an educational grant to disseminate carefully validated information on the use of antiepileptic drugs to treat bipolar disorder, funded by proceeds from the settlement of an illegal marketing lawsuit, underscoring the importance of carefully conducted treatment research for this patient population. In that issue, Chou and Fazzio reviewed the literature on evidence-based maintenance treatment of bipolar disorder. In that article, they noted that many clinical questions remain unaddressed, and they stressed the need for more research on special subpopulations, such as patients with a rapid-cycling course of illness.2 In that same issue, Ghaemi et al. reported promising results for a group of patients with treatment-resistant bipolar disorder, using a combination of lithium and lamotrigine.3 Also in that issue, Altman et al. reviewed predictors of relapse in bipolar disorder, such as stressful life events and lack of medication adherence, and they reported promising data on the protective role of various forms of psychotherapy in preventing relapse.4
In the May, 2007 issue of the Archives of General Psychiatry, Merikangas et al. reported results from the National Comorbidity Survey Replication study on the lifetime and 12-month prevalence of bipolar spectrum disorder.5 That article highlighted the substantial prevalence of the broad spectrum of bipolar disorders, which, in addition to bipolar I and II disorders, includes subthreshold presentations that are often underrecognized. The authors specified that clinically significant subthreshold bipolar disorder is at least as common as threshold bipolar disorder, that comorbidity is pervasive in patients with bipolar disorder, and that inappropriate treatment of bipolar disorder is a serious problem.
In this issue of the Journal, Reilly-Harrington et al. report a pilot study of the use of cognitive behavioral therapy (CBT) for rapid-cycling bipolar disorder, an important subpopulation within the bipolar disorder spectrum. Although the conclusions remain tentative due to the small sample size, the use of CBT for these patients shows promise and should be studied with larger groups of patients; it would also be interesting to evaluate the usefulness of intermittent CBT in ongoing maintenance treatment of these patients. Also in this issue, Neuhaus et al. describe the use of CBT in a partial hospital setting, pilot data that also look promising; a substantial percentage of the patients in this study had a primary diagnosis of bipolar disorder.
Regarding the notion of subthreshold bipolar spectrum disorder and common patterns of comorbidity, Goodman presents a review of symptom patterns that may represent the persistence of attention-deficit/hyperactivity disorder into adulthood, a condition frequently comorbid with bipolar disorder and other conditions. And, finally, Khan et al. present an interesting case of a woman presenting with bipolar symptoms and treated for bipolar disorder, who improved when hormonal replacement therapy was added. Whether this patient had been misdiagnosed as bipolar or her condition consisted of comorbid bipolar disorder and menopausal changes would be important to consider in her longitudinal follow-up care.
John Oldham, MD
1. Oldham J. Risky business. J Psychiatr Pract 2006;12:265.
2. Chou JC-Y, Fazzio L. Maintenance treatment of bipolar disorder: Applying research to clinical practice. J Psychiatr Pract 2006;12:283-99.
3. Ghaemi SN, Schrauwen E, Klugman J, et al. Long-term lamotrigine plus lithium for bipolar disorder: One year outcome. J Psychiatr Pract 2006;12:300-5.
4. Altman S, Haeri S, Cohen LJ, et al. Predictors of relapse in bipolar disorder: A review. J Psychiatr Pract 2006;12:269-82.
5. Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2007;64:543-52.