Bipolar Disorders, current research

Lithium Linked to Reduced Cancer Risk (Source: Medscape, 15.11.2016)

An average daily defined dose of 0.90, representative of adherence to medication (810 mg of lithium carbonate or 1187.1 mg of lithium sulfate per day), was associated with an HR of 0.425.

Although noting that the higher risk for cancer of bone, skin, and connective tissue was surprising, Dr Yang cautioned that “given small numbers of cancer cases, future studies will be needed to confirm those findings.”

Patients in the lithium group were younger than those in the anticonvulsant-only group (median age, 38.5 vs 45.9). Although the rate of physical comorbidity was lower for these patients, as determined by scores on the Charlson Comorbidity Index (P < .001), the rate of psychiatric comorbidities was higher, with the exception of anxiety.

Because lithium is indicated for the treatment of BD and manic episodes, little is known of the drug’s effects relating to cancer outside of that population, Dr Yang said.

The evidence pertaining to those with BD is nevertheless important, he added. Not all epidemiologic studies show increased cancer incidence in the BD population; those that do attribute the increase to various factors.

“Bipolar patients have an unhealthy lifestyle, such as tobacco smoking and alcohol use, which are identified as avoidable risk factors for cancer,” said Dr Yang.

BD prompts an immunity-inflammation response, and some inflammation-related marker levels are increased, such as high-sensitivity C-reactive protein and interleukin-1 receptor antagonist, predispose patients to immune-related diseases such as cancer.

Long-term lithium use was not linked to an increased risk for upper urinary tract cancer, although a smaller study found evidence of an increased risk for renal neoplasia.

Dr Pottegård pointed out that a drug that is seemingly associated with such a strong and general decrease in cancer risk, irrespective of the type of cancer, “contradicts our current understanding of cancer as a very heterogenic disease,” he said. “Such a strong effect on all types of cancer is simply not biologically plausible.”

“BD was not associated with increased cancer incidence and neither was lithium treatment in these patients,” the authors concluded. “Specifically, there was an increased risk of respiratory, gastrointestinal, and endocrine cancer in patients with BD without lithium treatment.”


At-risk individuals show possible treatment targets for bipolar disorder

Souce: J Psychiatr Res 2015; Advance online publication 26.02.2015

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Depressive, Anxiety, Behavioral Disorders may be risk factor for Bipolar Disorder. It may be important preceding clinical features in the onset of bipolar disorder, with the potential for targeted preventive care of at-risk individuals.

Patient aged 12 to 30 years showed that these disorders were more common among 118 individuals at high genetic risk for developing bipolar disorder than 110 individuals with no family risk.

The risk was increased a significant 2.6-fold for lifetime depressive disorders, a significant 2.7-fold for anxiety disorders and a nonsignificant 3.9-fold for behavioral disorders, after considering age, gender, ethnicity and home environment.

Among 44 patients with established bipolar disorder, the risk of having any prior anxiety disorder was increased nearly 9.7-fold compared with controls and 3.6-fold compared with at-risk individuals. Their risk of prior behavioral disorders was increased a significant 7.9-fold compared with controls whereas there was no significant difference compared with at-risk individuals.

The finding of an intermediate rate of psychopathology in the group between the bipolar and control samples – is consistent with this being a heterogeneous population. Contrary to previous reports neither anxiety disorders nor behavioral disorders predicted the onset of later affective disorders in the at-risk group, which the researchers suggest may be due to a limited sample size. However, prior behavioral disorders were significantly associated with the later onset of an affective disorder in those with established bipolar disorder.

These findings suggest the potential for targeted preventive treatment of such prior conditions to reduce the later onset of affective disorders in subjects at increased genetic risk for bipolar disorder.