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The International Journal of... Nov 2008This paper is a systematic review of the available data concerning the treatment of bipolar disorder: a systematic Medline search concerning treatment guidelines and... (Review)
Review
This paper is a systematic review of the available data concerning the treatment of bipolar disorder: a systematic Medline search concerning treatment guidelines and clinical trials. The search for treatment guidelines returned 583 articles and 913 papers for RCTs. The search was last performed on 1 March 2008. An additional search included repositories of clinical trials and previous systematic reviews in order to trace especially older trials. The literature suggests that lithium is useful during the acute manic and the maintenance phase. Both first- and second-generation antipsychotics are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also effective for treating bipolar depression, while olanzapine, quetiapine and aripiprazole are effective during the maintenance phase. Anticonvulsants, particularly valproate and carbamazepine have antimanic properties, whereas lamotrigine may be preferably effective in the treatment of depression but not mania. Antidepressants should always be used in combination with an antimanic agent because they were reported to induce switching to mania or hypomania, mixed episodes, and rapid cycling when given as monotherapy. The best evidence-based psychosocial interventions for bipolar disorder are group- and family-focused psychoeducation. Electroconvulsive therapy is an option for refractory patients. Although a variety of treatment options for bipolar disorder is currently available, their effectiveness is far from satisfactory, especially against bipolar depression and maintenance. Combination therapy may improve treatment outcome but it also carries the burden of more side-effects. Further research as well as the development of better guidelines and algorithms for step-by-step rational treatment are necessary.
Topics: Acute Disease; Anticonvulsants; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Guidelines as Topic; Humans; Long-Term Care; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 18752718
DOI: 10.1017/S1461145708009231 -
European Child & Adolescent Psychiatry Sep 2018It is important to understand new diagnostic entities in classifications of psychopathology such as the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)...
Comparing the DSM-5 construct of Disruptive Mood Dysregulation Disorder and ICD-10 Mixed Disorder of Emotion and Conduct in the UK Longitudinal Assessment of Manic Symptoms (UK-LAMS) Study.
It is important to understand new diagnostic entities in classifications of psychopathology such as the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (code F34.8) construct of Disruptive Mood Dysregulation Disorder (DMDD) and to compare it with possible equivalent disorders in other classificatory systems such as the International Classification of Diseases-10 (ICD-10), which has a category that superficially appears similar, that is, Mixed Disorder of Emotion and Conduct (MDEC) (code F92). In this study, the United Kingdom (UK) arm (UK-LAMS) of the US National Institute of Mental Health (NIMH) supported Longitudinal Assessment of Manic Symptoms (LAMS) multi-site study was used to evaluate and retrospectively construct DMDD and MDEC diagnoses in order to compare them and understand the conditions they co-occur with, in order to improve the clinical understanding. In particular, the phenomenology of UK-LAMS participants (n = 117) was used to determine whether DMDD is a unique entity within the DSM-5. The findings showed that 24 of 68 participants with either DMDD or MDEC (35.3%) fulfilled both diagnostic criteria for DMDD and MDEC, suggesting that these entities do contain overlapping features, particularly symptoms relating to Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD), Attention Deficit Hyperactivity Disorder (ADHD)/Hyperkinetic Disorder (HKD) and/or an anxiety disorder. The data also showed that most of the participants who met DMDD criteria also fulfilled the diagnostic criteria for ODD/CD, ADHD, followed by an anxiety disorder. In this context, this raises the issue whether DMDD is a unique construct or whether the symptomology for DMDD can be better explained as a specifier for ODD/CD and ADHD. Unlike DMDD, MDEC clearly specifies that the label should only be used if emotional and conduct disorders co-exist.
Topics: Affective Symptoms; Bipolar Disorder; Child; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Longitudinal Studies; Male; Mood Disorders; Prospective Studies; Psychopathology; United Kingdom
PubMed: 29730721
DOI: 10.1007/s00787-018-1149-5 -
Psychiatry Research Jan 2022Bipolar disorder is typified by episodes of manic/hypomanic and depressive symptoms, either distinctly or concurrently as mixed symptoms. While depressive symptoms are...
Bipolar disorder is typified by episodes of manic/hypomanic and depressive symptoms, either distinctly or concurrently as mixed symptoms. While depressive symptoms are the major driver of risk, it is unclear whether specific combinations of manic and anxiety symptoms contribute differentially to suicidal ideation and behavior in individuals with bipolar disorder during a depressive state. This study uses a quantitative application of Rothman's theoretical framework of causation, or 'causal pies' model. Data were obtained from the National Network of Depression Centers Mood Outcomes Program for 1028 visits from 626 individuals with bipolar disorder with current moderate-to-severe depressive symptoms, operationalized as a Patient Health Questionnaire-8 (PHQ-8) score ≥10. Mania symptoms were captured using the Altman Self-Rating Mania scale (ASRM) and anxiety symptoms were captured using the Generalized Anxiety Disorder-7 scale (GAD-7). The outcome of suicidal ideation or behavior was captured using the Columbia Suicide Severity Rating Scale (C-SSRS). In this cohort of individuals with bipolar disorder and at least moderate depressive symptoms, we found no increased risk of suicidal ideation or behavior attributable to manic and anxiety symptom clusters in individuals with bipolar disorder during depressive state. A small amount (4%) of risk was attributable to having severe depressive symptoms. These findings, however, may be influenced by limitations in sample size and measurement instruments. Future studies would benefit from larger samples and more rigorous assessments, including clinician-rated measures.
Topics: Anxiety; Anxiety Disorders; Bipolar Disorder; Humans; Mania; Suicidal Ideation
PubMed: 34852976
DOI: 10.1016/j.psychres.2021.114296 -
Journal of Child and Adolescent... Mar 2016The purpose of this study was to examine similarities and differences between disruptive mood dysregulation disorder (DMDD) and bipolar disorder not otherwise specified...
OBJECTIVE
The purpose of this study was to examine similarities and differences between disruptive mood dysregulation disorder (DMDD) and bipolar disorder not otherwise specified (BP-NOS) in baseline sociodemographic and clinical characteristics and 36 month course of irritability in children 6-12.9 years of age.
METHODS
A total of 140 children with DMDD and 77 children with BP-NOS from the Longitudinal Assessment of Manic Symptoms cohort were assessed at baseline, then reassessed every 6 months for 36 months.
RESULTS
Groups were similar on most sociodemographic and baseline clinical variables other than most unfiltered (i.e., interviewer-rated regardless of occurrence during a mood episode) Young Mania Rating Scale (YMRS) and parent-reported General Behavior Inventory-10 Item Mania (PGBI-10M) items. Children with DMDD received lower scores on every item (including irritability) except impaired insight; differences were significant except for sexual interest and disruptive-aggressive behavior. Children with DMDD received lower scores on eight of 10 PGBI-10M items, the other two items rated irritability. Youth with DMDD were significantly less likely to have a biological parent with a bipolar diagnosis than were youth with BP-NOS. Children with DMDD were more likely to be male and older than children with BP-NOS, both small effect sizes, but had nearly double the rate of disruptive behavior disorders (large effect). Caregiver ratings of irritability based on the Child and Adolescent Symptom Inventory-4R (CASI-4R) were comparable at baseline; the DMDD group had a small but significantly steeper decline in scores over 36 months relative to the BP-NOS group (b = -0.24, SE = 0.12, 95% CI -0.48 to -0.0004). Trajectories for both groups were fairly stable, in the midrange of possible scores.
CONCLUSIONS
In a sample selected for elevated symptoms of mania, twice as many children were diagnosed with DMDD than with BP-NOS. Children with DMDD and BP-NOS are similar on most characteristics other than manic symptoms, per se, and parental history of bipolar disorder. Chronic irritability is common in both groups. Comprehensive evaluations are needed to diagnose appropriately. Clinicians should not assume that chronic irritability leads exclusively to a DMDD diagnosis.
Topics: Aggression; Bipolar Disorder; Child; Child of Impaired Parents; Female; Humans; Irritable Mood; Longitudinal Studies; Male; Mood Disorders; Psychiatric Status Rating Scales; Twins, Dizygotic; Twins, Monozygotic
PubMed: 26859630
DOI: 10.1089/cap.2015.0062 -
Journal of Psychiatric Research Aug 2021Bipolar disorder often follows a set progression best described in stages where advanced stages are associated with poorer outcomes. Bipolar disorder is also often... (Randomized Controlled Trial)
Randomized Controlled Trial
Bipolar disorder often follows a set progression best described in stages where advanced stages are associated with poorer outcomes. Bipolar disorder is also often characterized by a predominance of episode polarity, where some individuals experience more depressive episodes (termed predominant depressive polarity) while others experience more hypo/manic episodes (termed predominant hypo/manic polarity). We examined the associations between staging and predominant polarity with measures of illness burden and treatment outcome utilizing data from a six-month comparative effectiveness trial of lithium and quetiapine in bipolar disorder (Bipolar CHOICE). We used number of self-reported lifetime mood (depressive and hypo/manic) episodes as a proxy for staging and ratio of depressive to manic episodes to define predominant polarity. Polarity and staging were correlated with several measures of burden of illness. Childhood abuse was correlated with more lifetime mood episodes, while more depressive episodes and depressive polarity were correlated with more anxiety disorder comorbidity. Depressive polarity was also correlated with more past trials of psychotropics, particularly antidepressants. However, neither staging nor predominant polarity moderated the randomized treatment effect of lithium vs. quetiapine. Number of depressive episodes in the past year was identified as a potential predictor of overall worse treatment outcome, regardless of medication condition. In conclusion, though staging and predominant episode polarity correlated with several measures of illness burden, they were not associated with differential treatment outcomes. This could be because many of our patients presented for treatment at advanced stages of illness and further highlights the need for early intervention in bipolar disorder.
Topics: Affect; Anxiety Disorders; Bipolar Disorder; Child; Cost of Illness; Humans; Treatment Outcome
PubMed: 34118638
DOI: 10.1016/j.jpsychires.2021.05.082 -
Journal (Canadian Dental Association) Jan 2003Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Given the shift in treatment regimens from the traditional institutionally... (Review)
Review
Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Given the shift in treatment regimens from the traditional institutionally based approach to more community-focused alternatives, general dental practitioners can expect to see and be asked to treat patients with various forms of psychiatric disorders. One such group consists of patients with bipolar disorder (including type I bipolar disorder or manic-depressive disorder). The purpose of this paper is to acquaint the dental practitioner with the psychopathological features of bipolar disorder and to highlight the oral health findings and dental management considerations for these patients. Bipolar disorder is considered one of the most treatable forms of psychiatric illness once it has been diagnosed correctly. Through a combination of pharmacotherapy, psychotherapy and life-adjustment skills counselling, these patients are better able to understand and cope with the underlying mood swings that typify the condition and in turn to interact more positively and progressively within society as a whole. Both the disease itself and its various pharmacologic management modalities exact a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. It is hoped that after reading this article the general dental practitioner will feel more confident about providing dental care for patients with bipolar disorder and in turn to become a vital participant in the reintegration of these patients into society.
Topics: Bipolar Disorder; Deinstitutionalization; Dental Care for Chronically Ill; Dental Caries; Drug Interactions; Humans; Lichen Planus, Oral; Lithium Carbonate; Oral Hygiene; Periodontal Diseases; Psychotherapy; Stomatitis; Xerostomia
PubMed: 12556265
DOI: No ID Found -
MedGenMed : Medscape General Medicine Aug 2002Bipolar disorders are currently divided into 4 entities: bipolar I, bipolar II, cyclothymic disorder, and bipolar disorder not otherwise specified, as described in the... (Review)
Review
Bipolar disorders are currently divided into 4 entities: bipolar I, bipolar II, cyclothymic disorder, and bipolar disorder not otherwise specified, as described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). These subtypes of bipolar disorders cover a spectrum of severities, frequencies, and durations of manic and depressive symptoms. The differential diagnosis among these and with regard to other disorders with similar symptom features remains the foundation for treatment of bipolar disorders. It is clear that much diversity exists within these major subtypes, such that designations like "rapid cycling" and "bipolar III" are being put forward and probed for clinical relevance. Some of the concerns and advantages of including these less-established manifestations of bipolar disorders in our diagnostic thinking are discussed here, and the utility and drawbacks of our current diagnostic protocols are considered.
Topics: Bipolar Disorder; Diagnosis, Differential; Humans; Mood Disorders
PubMed: 12466760
DOI: No ID Found -
Bipolar Disorders May 2021First, to investigate whether specific manic symptoms in preschool predict manic symptom severity in adolescence. Second, to investigate the interaction between family...
OBJECTIVES
First, to investigate whether specific manic symptoms in preschool predict manic symptom severity in adolescence. Second, to investigate the interaction between family history (FH) of bipolar disorder (BP) and preschool manic symptoms in predicting later adolescent manic symptom severity.
METHODS
This analysis utilized data from the Preschool Depression Study (PDS) which followed 306 preschoolers aged 3-6 years over time since 2003. Only subjects who had data both at baseline (age 3-6 years) and at or after age 12 were included (n = 122). Baseline manic symptom severity scores and diagnoses were assessed by the Preschool Age Psychiatric Assessment (PAPA). Manic symptoms severity at age ≥12 was assessed by the Kiddie Mania Rating Scale (KMRS). FH were ascertained by Family Interview for Genetic Studies (FIGS). Multilevel models of KMRS total score at age ≥12 by preschool mania symptoms with gender, baseline age, baseline ADHD, as well as baseline MDD diagnosis as covariates, and false discovery rate correction were used in statistical analysis.
RESULTS
Hypertalkativity, flight of ideas, uninhibited gregariousness, decreased need for sleep (DNFS), and increased motor pressure/ motor activity/ energy in preschool were associated with increased KMRS score at age ≥12. Racing thoughts, inappropriate laughing, and DNFS in early childhood were associated with higher manic symptoms in adolescence in subjects with FH of BP compared to those without FH.
CONCLUSION
The longitudinal clinical importance of displaying manic symptoms (racing thoughts, inappropriate laughing, and DNFS) in early childhood varies by FH. Among the aforementioned symptoms, DNFS was a robust predictor of later manic symptoms. Assessing FH of BP is very important in clinical risk prediction from early childhood.
Topics: Adolescent; Bipolar Disorder; Child; Child, Preschool; Humans; Psychiatric Status Rating Scales; Psychomotor Agitation
PubMed: 33450097
DOI: 10.1111/bdi.13046 -
Frontiers in Immunology 2021Tryptophan catabolites (TRYCATs) are implicated in the pathophysiology of mood disorders by mediating immune-inflammation and neurodegenerative processes. We performed a... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Tryptophan catabolites (TRYCATs) are implicated in the pathophysiology of mood disorders by mediating immune-inflammation and neurodegenerative processes. We performed a meta-analysis of TRYCAT levels in bipolar disorder (BD) patients compared to healthy controls.
METHODS
A systematic literature search in seven electronic databases (PubMed, Embase, Web of Science, Cochrane, Emcare, PsycINFO, Academic Search Premier) was conducted on TRYCAT levels in cerebrospinal fluid or peripheral blood according to the PRISMA statement. A minimum of three studies per TRYCAT was required for inclusion. Standardized mean differences (SMD) were computed using random effect models. Subgroup analyses were performed for BD patients in a different mood state (depressed, manic). The methodological quality of the studies was rated using the modified Newcastle-Ottawa Quality assessment Scale.
RESULTS
Twenty-one eligible studies were identified. Peripheral levels of tryptophan (SMD = -0.44; < 0.001), kynurenine (SMD = - 0.3; = 0.001) and kynurenic acid (SMD = -.45; = < 0.001) were lower in BD patients versus healthy controls. In the only three eligible studies investigating TRP in cerebrospinal fluid, tryptophan was not significantly different between BD and healthy controls. The methodological quality of the studies was moderate. Subgroup analyses revealed no significant difference in TRP and KYN values between manic and depressed BD patients, but these results were based on a limited number of studies.
CONCLUSION
The TRYCAT pathway appears to be downregulated in BD patients. There is a need for more and high-quality studies of peripheral and central TRYCAT levels, preferably using longitudinal designs.
Topics: Bipolar Disorder; Depression; Humans; Inflammation; Kynurenic Acid; Kynurenine; Tryptophan
PubMed: 34093561
DOI: 10.3389/fimmu.2021.667179 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jan 2018Individuals with bipolar disorder (BD) frequently suffer from cardiovascular disease (CVD), and it is a leading cause of mortality. Clinicians use routine laboratory...
OBJECTIVE
Individuals with bipolar disorder (BD) frequently suffer from cardiovascular disease (CVD), and it is a leading cause of mortality. Clinicians use routine laboratory tests, including a lipid profile, to predict cardiovascular risk. In addition, a particular lipid ratio, the atherogenic index of plasma (AIP), is a sensitive, new parameter that can be used to assess highrisk groups. To our knowledge, this is the first study evaluating cardiovascular risk via AIP in different stages of BD.
METHODS
The study group consisted of male patients with BD who were in a manic, depressive, or euthymic state, and age- and gender-matched healthy controls. Lipid profiles were analyzed and the AIP parameter of logarithm of triglyceride (TG) / high-density lipoprotein cholesterol (HDLc) was calculated for all of the participants. The significance level was set at p<0.05.
RESULTS
A total of 44 BD patients experiencing a manic episode, 35 depressive BD patients, 42 euthymic patients, and 41 healthy controls matched for age, gender, and smoking status were enrolled in the study. The AIP level was significantly different between groups (p=0.009). Pairwise comparisons of the groups revealed that the AIP level of depressive patients was significantly higher than that of the manic, euthymic, and control groups (p=0.013, p=0.048, and p=0.021, respectively). The AIP level was positively correlated with body mass index, waist circumference, metabolic syndrome, total cholesterol, low-density lipoprotein, and triglyceride level, and was negatively correlated with the HDLc level.
CONCLUSION
In this study, male BD patients in a depressive episode demonstrated an increase in cardiovascular risk. The significant correlations between AIP and other conventional cardiovascular risk factors indicate that AIP may be more useful to identify individuals with BD at high risk for CVD than absolute lipid parameters.
Topics: Adult; Atherosclerosis; Bipolar Disorder; Cardiovascular Diseases; Case-Control Studies; Humans; Male; Middle Aged; Risk Factors
PubMed: 29339689
DOI: 10.5543/tkda.2017.23350