Aggression treatment needed for patients with bipolar disorder

By Lucy Piper, Senior medwireNews Reporter

Patients with bipolar disorder are at increased risk for aggression, particularly when acutely ill, show results from a longitudinal study.

The researchers found that such patients reported more verbal and physical aggression, anger, and hostility than patients with other types of psychopathology and mentally healthy individuals.

Moreover, the association was independent of bipolar subtype, polarity, comorbidity, mood episode severity, psychosis, and medication use, reports the team, led by Javier Ballester, from Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania, USA.

The researchers point out that their results “do not mean that subjects with [bipolar disorder] are more prone to severe violent behaviors such as homicide, rape, or the use of weapons.”

But they say that they do “provide further evidence for the importance of preventing mood recurrences and implementing psychosocial and pharmacological treatments to help subjects with [bipolar disorder] manage their aggressiveness.”

After adjusting for significant demographic and clinical differences, the researchers found that 227 participants with bipolar disorder self-reported significantly higher total scores on the Aggression Questionnaire (AQ) at baseline than 75 patients with non-bipolar psychopathology and 81 mentally healthy individuals, at 87.1 versus 64.1 and 53.8, respectively.

Also, these differences in total scores persisted, with corresponding 2-year scores of 78.6 versus 63.3 and 50.7, and 4-year scores of 77.5 versus 59.8 and 49.6.

The bipolar disorder patients not only had higher total AQ scores, they also scored significantly higher than the other participants on all the individual subscales: physical aggression; verbal aggression; anger; hostility; and indirect aggression. And scores were highest among bipolar disorder patients during an acute mood episode.

Meanwhile, the difference in total and subscale AQ scores was not significant between patients with non-bipolar psychopathology and mentally healthy individuals.

Ballester and colleagues point out that for all the participants, aggression correlated significantly with overall functioning, and this was significantly lower in patients with bipolar disorder than in the other groups.

They conclude in Bipolar Disorders that “[s]uccessful acute treatment and prevention of recurrences will improve well-being, minimize interpersonal and family conflicts, and hopefully prevent the development of more severe violent behaviors in subjects with [bipolar disorder].”

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