Institute of Psychiatry holds lecture on new directions in mood disorder research

Quarter of human illness is mental and mood
disorders contribute more than cancer in this regard

Rawalpindi

Quarter of human illness is mental and studies gave a figure of 28 per cent for the disease burden by neuropsychiatric problems in different non-communicable diseases to disability-adjusted life-years worldwide. Mood disorders contribute more than cancer in this regard.

Chair of Mood Disorders at King’s College, London Professor Allan Young stated this while delivering a lecture here at the Institute of Psychiatry in Benazir Bhutto Hospital on the topic ‘Emerging Trends in Bipolar Disorder.’ Bipolar disorder can be defined as a mental condition marked by alternating periods of elation and depression.

The Institute organised the lecture by Professor Young who is president of the International Society for Affective Disorders. The distinguished guests included Dr. Imran Chaudhary, Dr. Ishrat Hussain, Brigadier Mowadat H. Rana and Brigadier Farrukh Hayyat. Consultants, residents, house officers and psychologists from the Institute of Psychiatry, KRL Hospital and the Armed Forces Institute of Mental Health were also in attendance.

Professor Young started his presentation with the depiction of a statue showing different phases of bipolar. This picture was taken from one of the gates of the Bethlem hospital. He said that bipolar disorders are often misdiagnosed as recurrent depressive disorder. He described recurrent affective (Mood) disorder as Bipolar I, II, mixed states, rapid cycling bipolar disorder and sub-syndromal states.

He then elaborated the course of bipolar disorder and its age of onset quoting from Merikangas et al published in Archives of General Psychiatry in 2011. He then explained the complexities in the diagnosis of bipolar depression like initial diagnosis can take more than or equal to 10 years and initial presentation is typically of depression. Also one-third of patients are misdiagnosed with Major Depressive Disorder. Co-morbidities are common and complicate diagnosis, he said.

Professor Young suggested that in older patients, first look for organicity particularly if its onset is after 50 years of age. Further, he added the historical aspects of bipolar affective disorder that mania and melancholia were recognised in the early stages of scientific medicine by Hippocrates in the 5th century BC. He was also the first physician to refer to them as ‘brain disorders’.

He added that in bipolar disorder, patients on follow up visits, more often present with depression and its sub-syndromal symptoms as compared to mania and hypomania and these issues should be appropriately addressed.

He then spoke of lifetime prevalence of specific co-morbid anxiety disorders in any bipolar disorder and showed that it is more as compared to co-morbid anxiety in major depressive disorder.

Prof. Young then narrated the natural history of bipolar disorder and called it extremely variable and complex. For the trainees he shared ten guiding questions in assessing any patient with bipolar affective disorder. He urged them to ask about recurrence, severity, episode of depression, hypomania and mixed state, psychiatric co-morbidity and physical ill-health, age of onset, family history, treatment history and functional/neurocognitive status.

He expressed the need to evaluate patients physically as it usually get neglected and contributes to psychiatric patients dying younger than the general population. He said that he believes that the Bipolar Brain has a great capacity to recover and he further added that on an average these patients have an IQ of 110.

He concluded his talk with a summary that bipolar disorders are common, clinical complex and costly. Diagnosis and treatment of bipolar disorders are complicated due to symptom overlap, heterogeneity of patient symptoms, co-morbidities and residual symptoms, he said.

He added that early, accurate diagnosis and appropriate treatment interventions are associated with improved patient outcomes. Restoration of patient functioning and quality of life are important treatment goals; cognition is important. Optimised treatment (pharmacotherapy and psychological in Mood Clinics) improves patient outcomes and this approach should be more widely adopted, said Professor Young.

He urged the attendees to be on the lookout for novel treatments. Professor of Psychiatry and Head of the Institute Professor Fareed A. Minhas concluded the session and thanked the guests and attendees for their time and attention.