Biomedical subjects

Alan G Mallinger

Publications and source records attributed to Alan G Mallinger.

21 records · Page 2Linked to original sources

PubMed2002

Suicide attempts in patients with bipolar I disorder during acute and maintenance phases of intensive treatment with pharmacotherapy and adjunctive psychotherapy.

OBJECTIVE: Lifetime rates of suicide attempts among patients with bipolar I disorder were compared to rates during a 2-year period of intensive treatment with pharmacotherapy and with one of two adjunctive psychosocial interventions. METHOD: Subjects entered the study during an acute mood episode. Subjects were treated with primarily lithium pharmacotherapy and with either psychotherapy specific to bipolar disorder, which included help in regularizing daily routines, or nonspecific, intensive clinical management involving regular visits with empathic clinicians. Data on prior suicide attempts were obtained retrospectively from interviews with the NIMH-Life-Chart method. Data on suicide attempts during the clinical trial were collected systematically throughout the protocol. RESULTS: The rate of suicide attempts was 1.05 per 100 person-months before patients entered the trial. Patients experienced a threefold reduction in the rate of suicide attempts during the acute treatment phase (until the patient achieved stabilization, defined by completion of 4 weeks during which the patient had a mean score of < or =7 on the 17-item Hamilton Depression Rating Scale and < or =7 on the Bech-Rafaelsen Mania Scale) and a 17.5-fold reduction during maintenance treatment. Poisson loglinear regression analysis modeling the relationship between the observed rates and the three protocol stages (pretreatment, acute, and maintenance) showed that the reductions were significant in the acute and maintenance phases, compared with the pretreatment phase. No patient with one or more suicide attempts before entering the trial attempted suicide during the protocol. CONCLUSIONS: A treatment program in a maximally supportive clinical environment can significantly reduce suicidal behavior in high-risk patients with bipolar I disorder.

Acute Disease↗

PubMed2002

Prevalence of obesity and weight change during treatment in patients with bipolar I disorder.

BACKGROUND: Obesity is a major public health concern in the United States and its prevalence is increasing. Individuals with bipolar disorder tend to be overweight, and their treatment may exacerbate obesity and increase the risk of concurrent medical disease in this population. METHOD: This retrospective report from the Pittsburgh Study of Maintenance Therapies in Bipolar Disorder examines the prevalence of overweight (body mass index [BMI] = 25.0-29.9) and obesity (BMI > or = 30.0) in 50 consecutive subjects with bipolar I disorder (DSM-IV) and evaluates weight change during acute treatment and the first year of maintenance treatment. RESULTS: At entry into the study, 34 (68%) of the patients in this sample with bipolar disorder were obese or overweight. The prevalence of obesity was high (16 [32%] of the 50 patients in our sample). The number of previous depressive episodes contributed to the likelihood of being overweight or obese at study entry. During the trial, most of the weight gain occurred during acute treatment rather than during maintenance treatment. During acute treatment, the amount of increase of BMI was positively related to the score on the Hamilton Rating Scale for Depression and negatively related to the score on Bech-Rafaelsen Mania Scale. There was a negative relationship between BMI and tendency to gain weight, during both acute and maintenance treatment. CONCLUSION: The high prevalence of obesity in subjects with bipolar disorder emphasizes the need for specific treatment strategies and programs for weight control for these individuals. The minimal weight gain during the maintenance phase, the relationship of acute depressive episodes to weight gain, and the fact that stabilization on maintenance medication may facilitate the participation in specific interventions for weight loss provide additional support for the practice of maintenance treatment.

Adult↗

PubMedDate not supplied

MRI investigation of temporal lobe structures in bipolar patients.

Previous anatomical MRI studies have suggested abnormalities in amygdala volumes in bipolar disorder, whereas hippocampus, temporal lobe (TL), and superior temporal gyri (STG) measures have been reported to be normal. This study further investigated the existence of anatomical abnormalities in these brain structures in bipolar subjects, to attempt to replicate previously reported findings. Twenty-four DSM-IV bipolar patients (mean age+/-S.D.=35+/-10 years) and 36 healthy controls (mean age+/-S.D.=37+/-10 years) were studied. 3D SPGR images were obtained with a 1.5T-GE Signa magnet (TR=25 ms, TE=5 ms, FOV=24 cm, slice-thickness=1.5 mm, matrix-size=256 x 192). Volumetric measurements of TL, hippocampus, amygdala, and STG were performed blindly, with a semi-automated software. Bipolar patients had significantly larger left amygdala volumes compared with controls (mean volumes+/-S.D.=2.57+/-0.69 vs. 2.17+/-0.58 ml, respectively; ANCOVA, age, gender, ICV as covariates; F=4.42, df=1/55, P=0.04). The volumes of the other temporal lobe structures did not differ significantly between the two groups (ANCOVA, age, gender, and ICV as covariates, P>0.05). Our findings of enlarged left amygdala in bipolar patients are in agreement with prior MRI studies, suggesting that abnormalities in this brain structure may be implicated in pathophysiology of the illness. Longitudinal studies in high-risk offspring and first-episode patients will be needed to examine whether such abnormalities precede the appearance of symptoms, or whether they may appear subsequently as a result of illness course.

Adult↗