Depression and Bipolar Disorder: Is Prevention of Mania Possible? Critical Issues on Diagnostic Criteria

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Gorini Amedei ◽  
M. Catena ◽  
F. Lejeune ◽  
S. Duma ◽  
M.A. Scarpato ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Diagnostic Criteria ◽  
Antidepressant Drugs ◽  
Epidemiological Survey ◽  
Careful Examination ◽  
Negative Consequences ◽  
Manic Depressive ◽  
Critical Issues ◽  
Dsm Iv ◽  
Depressive Episodes

Diagnostic criteria for bipolar disorder in DSM IV require the occurrence of a manic or hypomanic episode. The scant appropriateness of these criteria compared with Kraepelin"s concept of manic depressive insanity has been repeatedly reported and the concept of bipolar spectrum has been proposed for more than 30 years. The negative consequences of pure adherence to operational diagnostic criteria on clinical needs are presented in terms of community epidemiology results and in terms of clinical evidences and the inadequate treatment of depressive and anxiety episodes and the risk of manic switch with antidepressant drugs are discussed.The epidemiological survey conducted in Sesto Fiorentino showed that depressive episodes in patients with subthreshold mania or hypomania were different from the clinical presentation of pure unipolar depressives episodes confirming not only the numeric impact but also qualitative differences between these groups of patients.Our clinical study where predictors of mania have been prospectively evaluated in a trans nosographic sample of outpatients demonstrated that aspects related to bipolarity predicted manic shift regardless of the diagnosis. DSM IV criteria seem not to be able to detect and describe a group of patients relevant both on epidemiological and on clinical level. These findings underline the need of a careful examination of patients treatment and validate the rule of further research in definition of mood disorders boundaries for prevention strategies.

Manic-depressive illness — II: treatment outcome in bipolar disorder subtypes

1992 ◽  
Vol 9 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Patrick McKeon ◽  
Patrick Manley ◽  
Gregory Swanwick
Keyword(s):  
Bipolar Disorder ◽  
Treatment Outcome ◽  
Antidepressant Drugs ◽  
Depressive Illness ◽  
Tricyclic Antidepressant ◽  
Rapid Cycling ◽  
Manic Depressive Illness ◽  
Mood Changes ◽  
Manic Depressive ◽  
Manic Patients

AbstractThe treatment outcome of 100 bipolar disorder patients (B.P.) was examined retrospectively to determine whether bipolar subtypes had a differential prophylactic response to lithium, carbamazepine, neuroleptics and antidepressant drugs when these treatments were given in a predetermined sequence. Sixty-eight per cent of 53 B.P.-I patients with a mania-depression-normothymic-interval (M.D.I.) sequence of mood changes had a good response to lithium, and all but one of the remainder responded with the addition of carbamazepine or an antidepressant. While only 17% of 12 unipolar manic patients achieved prophylaxis with lithium and a further 17% when carbamazepine was added, the other 66% remained normothymic when a neuroleptic was prescribed with lithium. Of the seven rapid cycling patients where depression preceded mania, 28% had a good prophylactic effect with lithium, a further 28% when a tricyclic antidepressant was added and 14% with lithium and carbamazepine. None of the 18 rapid cycling M.D.I. group had a good response to lithium, but 39% stabilised when carbamazepine was added to lithium. Twenty-eight per cent of this group failed completely to respond to any of the treatments used. Neuroleptics increased the severity and duration of depressive phases for all subtypes except the unipolar mania group.

Combining Medication Treatment and Cognitive-Behavior Therapy for Bipolar Disorder

2007 ◽  
Vol 21 (1) ◽  
pp. 7-15 ◽  
Author(s):  
Monica Ramirez Basco ◽  
Gretchen Ladd ◽  
Diane S. Myers ◽  
David Tyler
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Processing ◽  
Psychosocial Functioning ◽  
Negative Impact ◽  
Work Productivity ◽  
Behavioral Model ◽  
Behavioral Changes ◽  
Negative Consequences ◽  
Family Responsibilities ◽  
Dsm Iv

Bipolar disorder (BPD) is a severe, recurrent psychiatric illness characterized by a chronic course of vacillating episodes of major depression and mania that impair functioning across many psychosocial domains (DSM–IV; DSM–IV-TR). Within each type of episode, changes occur in mood, cognitive processing, and regulation of vegetative functioning. Typical mood shifts include sadness (in depression) or euphoria (in mania). Either state can produce irritability, anxiety, and anger. In addition, both the process and the content of cognitive functioning are altered. Typical changes in process include decreased speed of thought in depression and increased speed of thought in mania. Content changes include negativity in depression and in mixed states, and grandiosity or paranoia in manic states. According to the cognitive-behavioral model of BPD (Basco & Rush, 2005), these changes in mood and cognition are accompanied by behavioral changes, typically increases in activity in mania and decreases in activity in depression. These behavioral changes, in turn, generally have a negative impact on the individual’s psychosocial functioning, such as slowed work productivity, neglect of household or family responsibilities, and reduced involvement in social activities, bring negative consequences to patients as well as those in their primary support groups. In mania, risk taking, disorganized behavior, sleep loss, and reduced medication adherence quickly exacerbate symptoms, reduce quality of functioning, and create significant psychosocial problems. BPD is sensitive to stress (Goodwin & Jamison, 1990). As symptoms alter functioning, new stressors are created as a consequence. Added stress exacerbates symptoms, and functioning may decline further.

scholarly journals Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

2009 ◽  
Vol 40 (2) ◽  
pp. 289-299 ◽  
Author(s):  
M. J. A. Tijssen ◽  
J. van Os ◽  
H.-U. Wittchen ◽  
R. Lieb ◽  
K. Beesdo ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Bipolar Disorder ◽  
Mental Health Care ◽  
Health Care Use ◽  
Symptom Scale ◽  
Childhood Disorders ◽  
Manic Symptoms ◽  
Dsm Iv ◽  
Depressive Episodes

BackgroundReported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.MethodIn 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).ResultsIncidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.ConclusionsThis study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

Pharmacotherapy of Bipolar Disorder

2016 ◽  
pp. 384-397
Author(s):  
Jay D. Amsterdam ◽  
Janusz K. Rybakowski
Keyword(s):  
Bipolar Disorder ◽  
First Generation ◽  
Psychiatric Comorbidity ◽  
Antidepressant Drugs ◽  
Term Treatment ◽  
Affective States ◽  
Pharmacological Interventions ◽  
Long Term Treatment ◽  
Depressive Episodes

Bipolar disorder (BD) is a recurrent and often chronic condition that is characterized by episodes of mania, hypomania, depression, and mixed affective states. BD affects up to 5% of the population, ranks sixth as a cause of worldwide disability among persons 15 to 44 years old, and has an estimated lifetime suicide rate of 10–20%. Pharmacotherapy remains one of the most important interventions for initial and long-term treatment of BD. In this chapter, pharmacological interventions for acute manic episodes, for acute depressive episodes, and for the prevention of recurrent affective episodes of either type are systematically presented, with special emphasis on the use of first-generation and second-generation mood-stabilizing drugs and antidepressant drugs. Special issues related to pharmacotherapy of BD are also discussed such as rapid cycling BD, mixed affective states, psychiatric comorbidity, and pregnancy and the postpartum period.

scholarly journals HLA-E circulating and genetic determinants in schizophrenia and bipolar disorder

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wahid Boukouaci ◽  
Mohamed Lajnef ◽  
Jean-Romain Richard ◽  
Ching-Lien Wu ◽  
Jihène Bouassida ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Killer Cell ◽  
Bipolar Disorders ◽  
Immune Dysregulation ◽  
Mental Illnesses ◽  
Genetic Determinants ◽  
Diagnostic Biomarkers ◽  
Dsm Iv ◽  
Depressive Episodes ◽  
Circulating Levels

AbstractSchizophrenia (SZ) and bipolar disorders (BD) are severe mental illnesses that lack reliable biomarkers to guide diagnosis and management. As immune dysregulation is associated with these disorders, we utilized the immunoregulatory functions of the natural killer cell inhibitory HLA-E locus to investigate the relationships between HLA-E genetic and expression diversities with SZ and BD risk and severity. Four hundred and forty-four patients meeting DSM-IV criteria for SZ (N = 161) or BD (N = 283) were compared to 160 heathy controls (HC). Circulating levels of the soluble isoform of HLA-E molecules (sHLA-E) were measured and HLA-E*01:01 and HLA-E*01:03 variants genotyped in the whole sample. sHLA-E circulating levels were significantly higher in both SZ and in BD patients compared to HC (pc < 0.0001 and pc = 0.0007 for SZ and BD, respectively). High sHLA-E levels were also observed in stable SZ patients and in acute BD patients experiencing depressive episodes when comparisons were made between the acute and stable subgroups of each disorder. sHLA-E levels linearly increased along HLA-E genotypes (p = 0.0036). In conclusion, HLA-E variants and level may have utility as diagnostic biomarkers of SZ and BD. The possible roles of HLA diversity in SZ and BD etiology and pathophysiology are discussed.

DSM

2021 ◽  
pp. 101-122
Author(s):  
Edward Shorter
Keyword(s):  
Bipolar Disorder ◽  
Mental Disorders ◽  
Mood Disorders ◽  
Diagnostic Criteria ◽  
Unipolar Depression ◽  
Discussion Group ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Manic Depressive ◽  
The Revolution

The decline of psychopharmacology began with the growing view that many of the diagnoses in the official Diagnostic and Statistical Manual of Mental Disorders (DSM) did not really exist. The paper that began the revolution in diagnosis in psychiatry was written by a discussion group of residents led by John Feighner. Then the DSM was drawn up using the diagnostic criteria known as the “Feighner criteria,” which Fritz Henn admitted were based on Emil Kraepelin's work. The various editions of Kraepelin's textbook in the 1900s lumped all the mood disorders into one big basin: manic-depressive insanity. In contrast, the ideas of Karl Leonhard provided a revolutionary recasting of the major illnesses that dismissed the Kraepelinian illness pool and implemented a strict division on the basis of polarity: unipolar depression vs. bipolar disorder.

Depressive episodes in stable schizophrenia: critical evaluation of the DSM-IV and ICD-10 diagnostic criteria

2003 ◽  
Vol 117 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Rodrigo A Bressan ◽  
Ana C Chaves ◽  
Lyn S Pilowsky ◽  
Itiro Shirakawa ◽  
Jair J Mari
Keyword(s):  
Diagnostic Criteria ◽  
Critical Evaluation ◽  
Icd 10 ◽  
Dsm Iv ◽  
Depressive Episodes

scholarly journals Prevalence of dementia in intellectual disability using different diagnostic criteria

2007 ◽  
Vol 191 (2) ◽  
pp. 150-157 ◽  
Author(s):  
A. Strydom ◽  
G. Livingston ◽  
M. King ◽  
A. Hassiotis
Keyword(s):  
Older Adults ◽  
Intellectual Disability ◽  
Diagnostic Criteria ◽  
Concurrent Validity ◽  
Epidemiological Survey ◽  
Moderate Dementia ◽  
Diagnosis Of Dementia ◽  
Icd 10 ◽  
Dsm Iv ◽  
Prevalence Of Dementia

BackgroundDiagnosis of dementia is complex in adults with intellectual disability owing to their pre-existing deficits and different presentation.AimsTo describe the clinical features and prevalence of dementia and its subtypes, and to compare the concurrent validity of dementia criteria in older adults with intellectual disability.MethodThe Becoming Older with Learning Disability (BOLD) memory study is a two-stage epidemiological survey of adults with intellectual disability without Down syndrome aged 60 years and older, with comprehensive assessment of people who screen positive. Dementia was diagnosed according to ICD-10, DSM-IV and DC-LD criteria.ResultsThe DSM – IV dementia criteria were more inclusive. Diagnosis using ICD – 10 excluded people with even moderate dementia. Clinical subtypes of dementia can be recognised in adults with intellectual disability. Alzheimer's dementia was the most common, with a prevalence of 8.6% (95% CI 5.2–13.0), almost three times greater than expected.ConclusionsDementia is common in older adults with intellectual disability, but prevalence differs according to the diagnostic criteria used. This has implications for clinical practice.

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