Bipolar Disorders

2020 ◽  
pp. 81-94
Author(s):  
Joel Paris
Keyword(s):  
Bipolar Disorder ◽  
Personality Disorders ◽  
Biological Markers ◽  
Wide Spectrum ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Bipolar Spectrum ◽  
Bipolar Ii ◽  
Affective Instability ◽  
Original Concept

Bipolar disorder is currently undergoing a diagnostic epidemic. This is because proponents of a broad bipolar spectrum, who can be called “bipolar imperialists” see latent bipolarity in a wide spectrum of other diagnoses. Thus bipolar disorders are being overdiagnosed in patients who are depressed, in patients who have affective instability related to personality disorders, and in children who mainly present with irritability. None of these patients demonstrate manic episodes or the hypomanic episodes required to diagnose bipolar-II. There are no biological markers to support this expansion of the original concept of bipolarity. The result has been a vast over-prescription of “mood stabilizers” and antipsychotics, both in adults and in children.

Bipolar Disorders

2015 ◽  
pp. 81-94
Author(s):  
Joel Paris
Keyword(s):  
Personality Disorders ◽  
Child Psychiatry ◽  
Behavior Disorders ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Bipolar Spectrum ◽  
Pharmacological Interventions ◽  
Affected Child ◽  
Affective Instability ◽  
Contemporary Practice

The overdiagnosis of bipolar disorders is one of the most troubling problems affecting contemporary practice. The concept of a bipolar spectrum has led to unnecessary pharmacological interventions in patients who do not have the classical symptoms of bipolarity. There has also been a failure to distinguish bipolarity from affective instability, which is often a feature of personality disorders. Patients who do not respond to antidepressants may be mistakenly prescribed mood stabilizers. The overdiagnosis of bipolar disorders has also affected child psychiatry, in that children who have severe behavior disorders and irritiability are seen as falling within the spectrum.

scholarly journals The relationship between borderline personality disorder and bipolar disorder

2013 ◽  
Vol 15 (2) ◽  
pp. 155-169 ◽  
Keyword(s):  
Bipolar Disorder ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Bipolar Spectrum ◽  
Bipolar Ii ◽  
Axis I ◽  
Bipolar Patients ◽  
The Relationship

It is clinically important to recognize both bipolar disorder and borderline personality disorder (BPD) in patients seeking treatment for depression, and it is important to distinguish between the two. Research considering whether BPD should be considered part of a bipolar spectrum reaches differing conclusions. We reviewed the most studied question on the relationship between BPD and bipolar disorder: their diagnostic concordance. Across studies, approximately 10% of patients with BPD had bipolar I disorder and another 10% had bipolar II disorder. Likewise, approximately 20% of bipolar II patients were diagnosed with BPD, though only 10% of bipolar I patients were diagnosed with BPD. While the comorbidity rates are substantial, each disorder is nontheless diagnosed in the absence of the other in the vast majority of cases (80% to 90%). In studies examining personality disorders broadly, other personality disorders were more commonly diagnosed in bipolar patients than was BPD. Likewise, the converse is also true: other axis I disorders such as major depression, substance abuse, and post-traumatic stress disorder are also more commonly diagnosed in patients with BPD than is bipolar disorder. These findings challenge the notion that BPD is part of the bipolar spectrum.

Pharmacological Treatments for Bipolar Disorder

2007 ◽  
pp. 323-350 ◽  
Author(s):  
Paul E. Keck ◽  
Susan L. McElroy
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Pharmacological Management ◽  
Randomized Controlled ◽  
Bipolar Ii ◽  
Depressive Episodes ◽  
Subsyndromal Symptoms

The vast majority of clinical trials in patients with bipolar disorders have been conducted in groups with bipolar I illness, although a few trials have recently emerged specifically in patients with bipolar II disorder. The pharmacological management of bipolar disorder involves the treatment of acute manic, hypomanic, mixed, and depressive episodes, as well as the prevention of further episodes and subsyndromal symptoms. Lithium, divalproex, carbamazepine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole have demonstrated efficacy in the treatment of acute mania in randomized, controlled (Type 1) trials. Although the pharmacological treatment of acute bipolar depression remains understudied, data from randomized, controlled trials indicate that lithium, olanzapine, olanzapine-fluoxetine, quetiapine, lamotrigine, tricyclics, MAOIs, fluoxetine, and pramipexole have efficacy in this phase of the illness. The optimal duration of antidepressant treatment, in combination with mood stabilizers, is still unknown. Lithium, lamotrigine, olanzapine, and aripiprazole have been shown to have efficacy in relapse prevention. Less extensive data suggest that divalproex and carbamazepine are also efficacious as preventative treatments.

scholarly journals Introduction: The Impact and Management of the Bipolar Spectrum in 2004

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S12) ◽  
pp. 5-5
Author(s):  
Eric Hollander
Keyword(s):  
Bipolar Disorder ◽  
Psychosocial Interventions ◽  
High Rate ◽  
Health Concern ◽  
Bipolar Spectrum ◽  
Bipolar Ii ◽  
Affective Instability ◽  
Cluster B Personality Disorders ◽  
Pharmacologic Treatments ◽  
The Impact

This academic supplement to CNS Spectrums high-lights the impact of the broader bipolar spectrum as a considerable public health concern, the side effects that must be considered in a risk/benefit analysis of effective pharmacologic treatments of bipolar disorder, and the state of the art of psychosocial interventions utilized to manage the disorder.One important development in the conceptualization of bipolar disorder is that a common underlying endophenotype may mediate a range of presentations manifesting as the broader bipolar spectrum. This includes variants of bipolar disorder, such as bipolar II, cyclothymia, and mixed states; disorders characterized by affective instability, such as cluster B personality disorders; and disorders characterized by impulsivity associated with affective instability, such as impulse-control disorders. Since there may be various phenotypic expressions of a common underlying endophenotype, this may also help to explain the high rate of comorbidity found in bipolar disorder.

Magnetic resonance spectroscopic measurement of cerebral gamma-aminobutyric acid concentrations in patients with bipolar disorders

2006 ◽  
Vol 18 (2) ◽  
pp. 120-126 ◽  
Author(s):  
Po W. Wang ◽  
Napapon Sailasuta ◽  
Rebecca A. Chandler ◽  
Terence A. Ketter
Keyword(s):  
Bipolar Disorder ◽  
Magnetic Resonance ◽  
Mood Disorders ◽  
Bipolar Disorders ◽  
Occipital Lobe ◽  
Gabaergic Neurotransmission ◽  
Control Subjects ◽  
Bipolar Ii ◽  
Healthy Control ◽  
Cr Concentration

Background:Animal models of depression and psychopharmacological mechanisms of action suggest the importance of the gamma-amino butyric acid (GABA) system in the pathophysiology of mood disorders. Mood stabilizers have overlapping effects on GABAergic neurotransmission, and antidepressant use has been associated with alterations in GABAB receptor function. Magnetic resonance spectroscopy (MRS) provides an opportunity to noninvasively assess cerebral GABA concentrations in anterior paralimbic circuits that have been implicated in mood disorders.Methods:In bipolar disorder patients and healthy control subjects, we used MRS with a modified GABA-edited point resolved spectroscopy sequence (TE 68 ms, TR 1500 ms, 512 averages, total scan time 26 min) to assess GABA in an 18-cm3 occipital voxel. In addition, in another cohort of bipolar disorder patients and healthy control subjects, we similarly assessed GABA in a 12.5-cm3 medial prefrontal/anterior cingulate (MPF/AC) voxel. The concentration of GABA was referenced to creatine (Cr) from unedited spectra.Results:In bipolar patients and controls, we consistently detected 3.0 p.p.m. GABA peaks in occipital lobe and MPF/AC. In 16 bipolar (nine bipolar I and seven bipolar II) disorder patients, compared with six healthy control subjects, mean occipital GABA/Cr concentration was 61% higher. In addition, in 15 bipolar (five bipolar I, nine bipolar II, and one bipolar not otherwise specified) disorder patients, compared with six healthy control subjects, mean MPF/AC GABA/Cr concentration tended to be 41% higher.Conclusions:Patients with bipolar disorders may have increased cerebral GABA concentrations. Although this was more evident in the occipital lobe, MPC/AC GABA disturbance may be of greater potential interest in view the more established role of MPF/AC in affective processing. Additional studies are warranted to assess changes in GABAergic neurotransmission and the influences of diagnosis, mood state, and medication status in bipolar disorder patients.

Mood Stabilizers in the Treatment of Substance Use Disorders

CNS Spectrums ◽  
2010 ◽  
Vol 15 (2) ◽  
pp. 95-109 ◽  
Author(s):  
Icro Maremmani ◽  
Matteo Pacini ◽  
Francesco Lamanna ◽  
Pier Paolo Pani ◽  
Giulio Perugi ◽  
...  
Keyword(s):  
Substance Use ◽  
Dual Diagnosis ◽  
Substance Abusers ◽  
Bipolar Disorders ◽  
Preliminary Evidence ◽  
Mood Stabilizers ◽  
Bipolar Spectrum ◽  
Bipolar Spectrum Disorders ◽  
Spectrum Disorders

ABSTRACTIndividuals suffering from drug addiction may also manifest features of bipolar spectrum disorders. Hyperthymic and cyclothymic temperaments may render individuals vulnerable to later development of substance abuse. Bipolar disorders themselves may be altered or precipitated by substance use, most notably by stimulants (amphetamines), alcohol, and cannabinoids.The clinical usefulness of mood stabilizers, particularly antiepileptics, has been established as safe and effective in substance abusers with and without comorbid mood disorders. Most studies on this issue have been of short duration and focused on the resolution of a currently manifest period of illness. Few studies have been conducted on the usefulness of these drugs on the long-term longitudinal course of these diseases, such as frequently encountered recurrent relapses into states of agitation, impulsivity, and/or dissatisfaction. As opposed to the clinical experience with traditional antidepressants and neuroleptics, antiepileptics do not induce counter-polar states (depressed patients abruptly turning manic or hypomanic; nor patients currently hypomanic or manic turning abruptly depressed). Many clinicians consider antiepileptic mood stabilizers to be the preferred category of medications for the treatment of such patients. Valproate appears to be a potentially fruitful medication to study in these dual diagnosis patients due to preliminary evidence demonstrating its anticraving efficacy.

Treatment and Prevention of Depression

2002 ◽  
Vol 3 (2) ◽  
pp. 39-77 ◽  
Author(s):  
Steven D. Hollon ◽  
Michael E. Thase ◽  
John C. Markowitz
Keyword(s):  
Bipolar Disorder ◽  
Behavioral Interventions ◽  
Combined Treatment ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Delayed Effect ◽  
Convulsive Therapy ◽  
Adequate Treatment ◽  
Acute Distress ◽  
Reduce Risk

Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.

scholarly journals Regional lithium prescription rates and recurrence in bipolar disorder

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Martin Sköld ◽  
Sindre Rolstad ◽  
Erik Joas ◽  
Mathias Kardell ◽  
Erik Pålsson ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Disorders ◽  
Population Level ◽  
Bipolar I Disorder ◽  
Not Otherwise Specified ◽  
Number Of Patients ◽  
Bipolar Ii ◽  
National Quality ◽  
Prescription Rates ◽  
Depressive Episodes

Abstract Background Lithium is the best documented maintenance treatment in bipolar disorder, but its use varies considerably across and within countries. It is not known whether regional differences in lithium prescription rates translate to differing regional outcomes. Aims To estimate associations between county specific lithium prescription rates and county specific recurrence odds of bipolar disorder in Sweden. Method Data from 14,616 patients with bipolar I disorder, bipolar II disorder, or bipolar disorder not otherwise specified were extracted from the Swedish national quality assurance register for bipolar disorders (BipoläR). Lithium prescription frequencies were calculated for 21 counties. Logistic regression analyses were run adjusted for confounders, with any type of recurrence as primary outcome, and incident elated and depressive episodes as secondary outcomes. Subsets of patients with bipolar I, II and not otherwise specified disorder were also analysed separately. Results Lithium prescription rates for populations with all bipolar subtypes ranged across counties from 37.7 to 84.9% (mean 52.4%). Higher regional prescription rates were significantly associated with lower rate of any type of recurrence. The association was stronger when bipolar I disorder was analysed separately. Conclusions The advantages for lithium use long acknowledged for bipolar I disorder are also seen for the rest of the bipolar spectrum. Results suggest that population level outcomes of bipolar disorder could be improved by increasing the number of patients using lithium.

The assessment and management of suicide risk in bipolar disorder

2017 ◽  
Author(s):  
Zoltán Rihmer ◽  
Xénia Gonda ◽  
Péter Döme
Keyword(s):  
Bipolar Disorder ◽  
Suicide Risk ◽  
Bipolar Disorders ◽  
Evidence Based ◽  
Bipolar Spectrum ◽  
Bipolar Spectrum Disorders ◽  
Spectrum Disorders ◽  
Bipolar Patients ◽  
Routine Assessment ◽  
Commit Suicide

Bipolar spectrum disorders are among the most frequent psychiatric ailments associated with a considerable risk of suicidal behaviour. Approximately 4–19% of (mostly untreated) patients with bipolar disorders ultimately commit suicide, and about 20–60% of them make at least one suicide attempt in their lifetime. Compared with the general population, the risk of committing suicide is about 10–30 times higher in patients with bipolar disorder. However, the majority of bipolar patients never attempt or commit suicide. Therefore, the routine assessment of several risk factors for suicide in clinical practice may aid in the recognition of those patients who are at the highest risk. This chapter summarizes the clinically most relevant suicide risk and protective factors in bipolar disorders. In addition, we review evidence-based strategies for suicide prevention in bipolar disorder.

Mood Stabilizers: Implementing Combined Treatment Regimens in Bipolar Disorder

2018 ◽  
Author(s):  
Charles Bowden ◽  
Melissa Martinez
Keyword(s):  
Bipolar Disorder ◽  
Treatment Planning ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Combined Treatment ◽  
Bipolar Disorders ◽  
Maintenance Phase ◽  
Mood Stabilizers ◽  
Outcome Analysis ◽  
Treatment Regimens

Patients with bipolar disorders spend a greater proportion of their illness in a depressed or mixed state rather than experiencing either mania or hypomania. Over the past 20 years, most major pharmaceutical companies have either reduced or abandoned the research and development of novel psychiatric drugs, exiting the development of new, safe, efficacious, and tolerable treatment regimens for bipolar disorder. Therefore, optimizing the current treatments available is critical. We review studies of the last 15 years that provide guidance relevant to managing the maintenance phase of bipolar disorders. Based on these data, we provide recommendations for effective treatment planning and implementation, principally for the maintenance phase care of persons with bipolar disorder. We also discuss strategies for implementing medication regimens, differentiating strategies for maintenance phase treatment from those of acute phase treatment. Assessing key symptoms that are sensitive to change is critical for longitudinal assessments and treatment planning for patients with bipolar disorders. In most studies, only a subset of rating scale items differentiate patients with good responses from those without. Identified symptoms include racing thoughts, less need for sleep, hyperactivity, increased activity, and increased energy. We developed a procedure for using Multistate Outcome Analysis of Treatment (MOAT) in bipolar disorders. MOAT integrates efficacy and tolerability data during studies to provide information about the quantity and quality of time spent in distinct mood states. The protocol developed will be useful for assessing treatment strategies in bipolar disorder. This review contains 4 figures, 7 tables and 32 references Key words: bipolar, depression, lithium, mania, mixed, mood stabilizer, survival analysis, symptom domains, valproate

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