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Psychiatry and Clinical Neurosciences Sep 2018Sleep disturbances and circadian rhythm dysfunction have been widely demonstrated in patients with bipolar disorder (BD). Irregularity of the sleep-wake rhythm,... (Review)
Review
Sleep disturbances and circadian rhythm dysfunction have been widely demonstrated in patients with bipolar disorder (BD). Irregularity of the sleep-wake rhythm, eveningness chronotype, abnormality of melatonin secretion, vulnerability of clock genes, and the irregularity of social time cues have also been well-documented in BD. Circadian rhythm dysfunction is prominent in BD compared with that in major depressive disorders, implying that circadian rhythm dysfunction is a trait marker of BD. In the clinical course of BD, the circadian rhythm dysfunctions may act as predictors for the first onset of BD and the relapse of mood episodes. Treatments focusing on sleep disturbances and circadian rhythm dysfunction in combination with pharmacological, psychosocial, and chronobiological treatments are believed to be useful for relapse prevention. Further studies are therefore warranted to clarify the relation between circadian rhythm dysfunction and the pathophysiology of BD to develop treatment strategies for achieving recovery in BD patients.
Topics: Bipolar Disorder; Chronobiology Disorders; Depressive Disorder, Major; Endophenotypes; Humans; Sleep Wake Disorders
PubMed: 29869403
DOI: 10.1111/pcn.12688 -
CNS Drugs Sep 2015Approximately 40% of patients with bipolar disorder experience mixed episodes, defined as a manic state with depressive features, or manic symptoms in a patient with... (Review)
Review
Approximately 40% of patients with bipolar disorder experience mixed episodes, defined as a manic state with depressive features, or manic symptoms in a patient with bipolar depression. Compared with bipolar patients without mixed features, patients with bipolar mixed states generally have more severe symptomatology, more lifetime episodes of illness, worse clinical outcomes and higher rates of comorbidities, and thus present a significant clinical challenge. Most clinical trials have investigated second-generation neuroleptic monotherapy, monotherapy with anticonvulsants or lithium, combination therapy, and electroconvulsive therapy (ECT). Neuroleptic drugs are often used alone or in combination with anticonvulsants or lithium for preventive treatment, and ECT is an effective treatment for mixed manic episodes in situations where medication fails or cannot be used. Common antidepressants have been shown to worsen mania symptoms during mixed episodes without necessarily improving depressive symptoms; thus, they are not recommended during mixed episodes. A greater understanding of pathophysiological processes in bipolar disorder is now required to provide a more accurate diagnosis and new personalised treatment approaches. Targeted, specific treatments developed through a greater understanding of bipolar disorder pathophysiology, capable of affecting the underlying disease processes, could well prove to be more effective, faster acting, and better tolerated than existing therapies, therefore providing better outcomes for individuals affected by bipolar disorder. Until such time as targeted agents are available, second-generation neuroleptics are emerging as the treatment of choice in the management of mixed states in bipolar disorder.
Topics: Antidepressive Agents; Bipolar Disorder; Clinical Trials as Topic; Databases, Bibliographic; Disease Management; Electroconvulsive Therapy; Humans
PubMed: 26369921
DOI: 10.1007/s40263-015-0275-6 -
Current Psychiatry Reports Mar 2019Disruptions in circadian rhythms are believed to underlie the illness course of bipolar disorder (BD). This review evaluates recent studies on the treatment of circadian... (Review)
Review
PURPOSE OF REVIEW
Disruptions in circadian rhythms are believed to underlie the illness course of bipolar disorder (BD). This review evaluates recent studies on the treatment of circadian dysfunction in BD.
RECENT FINDINGS
Targeted social rhythm therapy may be useful for bipolar depression though some studies suggest that a non-targeted psychosocial or pharmacological intervention may be just as efficacious. Lithium holds potential for addressing circadian dysfunction in BD. Blue-blocking therapy may be useful for mania and midday bright light therapy may relieve depression.
CONCLUSIONS
Psychosocial, pharmacological, and light-based approaches are promising avenues for treating circadian dysfunction in BD.
Topics: Bipolar Disorder; Circadian Rhythm; Depression; Depressive Disorder; Humans; Lithium Compounds; Phototherapy
PubMed: 30826893
DOI: 10.1007/s11920-019-1001-8 -
The International Journal of... Aug 2019People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In...
People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described.
Topics: Bipolar Disorder; Combined Modality Therapy; Health Status; Humans; Mental Health; Quality of Life; Treatment Outcome
PubMed: 31093646
DOI: 10.1093/ijnp/pyz018 -
Evidence-based Mental Health Nov 2018Bipolar disorder (BPD) is a potentially lifelong condition characterised by extreme changes in mood that may begin in childhood and cause substantial impairment. Over... (Review)
Review
Bipolar disorder (BPD) is a potentially lifelong condition characterised by extreme changes in mood that may begin in childhood and cause substantial impairment. Over the past decades, BPD has been the focus of increased attention mainly due to controversies surrounding its prevalence, diagnosis and treatment in children and adolescents. This report addresses these controversies by reviewing the extant evidence base, providing clinicians with a summary of the literature on diagnosis, phenomenology and treatment of paediatric BPD. The debate regarding diagnosing children with BPD based on severe irritability and aggression is mostly resolved. The current data support utilising the diagnostic criteria based on episodic changes of mood polarity. Therefore, longitudinal course of illness should be explored in detail when diagnosing BPD. Given high rates of genetic predisposition for BPD, assessment of youth should focus on obtaining accurate family history of this condition. Additionally, there has been a substantial increase in randomised placebo-controlled clinical trials evaluating pharmacological agents for mood stabilisation in children and adolescents, which we summarise in this review. Despite significant progress being made in the field of paediatric BPD, more research is needed in the areas of phenomenology, pathophysiology, course and treatment of this condition in youth.
Topics: Adolescent; Bipolar Disorder; Child; Humans
PubMed: 30327338
DOI: 10.1136/eb-2018-102912 -
The Journal of Clinical Psychiatry Oct 2015Bipolar depression is difficult to diagnose and is often mistaken for unipolar depression. Unfortunately, this misdiagnosis creates a cascade of negative outcomes.... (Review)
Review
Bipolar depression is difficult to diagnose and is often mistaken for unipolar depression. Unfortunately, this misdiagnosis creates a cascade of negative outcomes. Patients will probably receive inadequate or inappropriate treatment that will not alleviate the symptoms or impairment of the disorder and may even further destabilize their mood. These individuals are then at risk for experiencing numerous social and occupational impairments, alcohol or substance abuse, and suicidal behavior. An accurate diagnosis and appropriate treatment of bipolar disorder are necessary to prevent this chain of potentially disastrous events.
Topics: Bipolar Disorder; Diagnostic Errors; Humans; Treatment Failure
PubMed: 26528666
DOI: 10.4088/JCP.14016tx2c -
The Journal of Clinical Psychiatry May 2019The purpose of this article is to provide psychiatrists and other health care professionals who treat patients with major depressive disorder and bipolar disorder a set...
The purpose of this article is to provide psychiatrists and other health care professionals who treat patients with major depressive disorder and bipolar disorder a set of best practices, tools, and other methods to improve their ability to make a more accurate diagnosis between major depressive disorder and bipolar disorder and to reach this diagnosis sooner, given a particular set of patient-related circumstances and comorbidities..
Topics: Benchmarking; Bipolar Disorder; Depressive Disorder, Major; Diagnosis, Differential; Humans
PubMed: 31091027
DOI: 10.4088/JCP.ot18043ah2 -
Australian Family Physician Sep 2013Bipolar disorder affects about 1% of Australians and impacts severely on relationships, careers and general functional capacity. General practitioners are central in the...
BACKGROUND
Bipolar disorder affects about 1% of Australians and impacts severely on relationships, careers and general functional capacity. General practitioners are central in the management of patients with bipolar disorder.
OBJECTIVE
To update clinicians on the recognition, diagnosis and management of bipolar disorder in light of recent research.
DISCUSSION
There is growing concern about the over-diagnosis of bipolar disorder, and increasing evidence that bipolar depression may present differently to unipolar depression. Antipsychotics are the initial agents of choice for the acute treatment of mania. For preventive treatment, lithium and atypical antipsychotics have the strongest evidence base. Lithium has been shown to be more effective than valproate. The main effect of lithium and most of the atypical antipsychotics is on prevention of manic relapse; only olanzapine and quetiapine also protect against depression. Lamotrigine is an agent with evidence for prevention of depressive relapse, but have minimal activity against mania. The role of antidepressants remains contentious, while there is strong support for quetiapine. Finally, there is growing evidence from randomised controlled trials of the benefit of psychological therapies in conjunction with medications.
Topics: Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Humans; Lithium; Secondary Prevention
PubMed: 24024220
DOI: No ID Found -
The Israel Journal of Psychiatry and... 2012
Topics: Adolescent; Bipolar Disorder; Child; Humans
PubMed: 22652924
DOI: No ID Found -
JAMA Psychiatry May 2020Behavioral high-risk phenotypes predict the onset of bipolar disorder among youths who have parents with bipolar disorder. Few studies have examined whether early... (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Behavioral high-risk phenotypes predict the onset of bipolar disorder among youths who have parents with bipolar disorder. Few studies have examined whether early intervention delays new mood episodes in high-risk youths.
OBJECTIVE
To determine whether family-focused therapy (FFT) for high-risk youths is more effective than standard psychoeducation in hastening recovery and delaying emergence of mood episodes during the 1 to 4 years after an active period of mood symptoms.
DESIGN, SETTINGS, AND PARTICIPANTS
This multisite randomized clinical trial included referred youths (aged 9-17 years) with major depressive disorder or unspecified (subthreshold) bipolar disorder, active mood symptoms, and at least 1 first- or second-degree relative with bipolar disorder I or II. Recruitment started from October 6, 2011, and ended on September 15, 2016. Independent evaluators interviewed participants every 4 to 6 months to measure symptoms for up to 4 years. Data analysis was performed from March 13 to November 3, 2019.
INTERVENTIONS
High-risk youths and parents were randomly allocated to FFT (12 sessions in 4 months of psychoeducation, communication training, and problem-solving skills training; n = 61) or enhanced care (6 sessions in 4 months of family and individual psychoeducation; n = 66). Youths could receive medication management in either condition.
MAIN OUTCOMES AND MEASURES
The coprimary outcomes, derived using weekly psychiatric status ratings, were time to recovery from prerandomization symptoms and time to a prospectively observed mood (depressive, manic, or hypomanic) episode after recovery. Secondary outcomes were time to conversion to bipolar disorder I or II and longitudinal symptom trajectories.
RESULTS
All 127 participants (82 [64.6%] female; mean [SD] age, 13.2 [2.6] years) were followed up for a median of 98 weeks (range, 0-255 weeks). No differences were detected between treatments in time to recovery from pretreatment symptoms. High-risk youths in the FFT group had longer intervals from recovery to the emergence of the next mood episode (χ2 = 5.44; P = .02; hazard ratio, 0.55; 95% CI, 0.48-0.92;), and from randomization to the next mood episode (χ2 = 4.44; P = .03; hazard ratio, 0.59; 95% CI, 0.35-0.97) than youths in enhanced care. Specifically, FFT was associated with longer intervals to depressive episodes (log-rank χ2 = 6.24; P = .01; hazard ratio, 0.53; 95% CI, 0.31-0.88) but did not differ from enhanced care in time to manic or hypomanic episodes, conversions to bipolar disorder, or symptom trajectories.
CONCLUSIONS AND RELEVANCE
Family skills-training for youths at high risk for bipolar disorder is associated with longer times between mood episodes. Clarifying the relationship between changes in family functioning and changes in the course of high-risk syndromes merits future investigation.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT01483391.
Topics: Adolescent; Bipolar Disorder; Child; Disease Progression; Family Therapy; Female; Humans; Male; Mood Disorders; Psychotropic Drugs; Treatment Outcome
PubMed: 31940011
DOI: 10.1001/jamapsychiatry.2019.4520