Staging and neuroprogression in bipolar disorder: treatment implications

2017 ◽  
Author(s):  
Ives Cavalcante Passos ◽  
Flávio Kapczinski
Keyword(s):  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Behaviour Therapy ◽  
Brain Circuits ◽  
Cognitive Behaviour ◽  
Disorder Treatment ◽  
Clinical Questions ◽  
The Brain ◽  
Progressive Course

It is known that if, not all, a substantial proportion of patients with bipolar disorder (BD) present a progressive course with functional and cognitive impairment. In addition, patients with BD and multiple mood episodes have a worse response to lithium and cognitive behaviour therapy. However, many current treatment guidelines do not take these clinical features that change with illness progression into account. In order to clarify these clinical questions, the term ‘neuroprogression’ was conceptualized as the pathological rewiring of the brain that takes place in parallel with the clinical deterioration in the course of BD. It provides a heuristic basis for conceptualizing the biochemical foundation of changes in brain circuits related to the progressive course of BD. Herein, we aim to review risk factors, biological underpinnings, and treatment implications related to neuroprogression in BD.

scholarly journals Cognitive behaviour therapy meets psychopharmacotherapy

2010 ◽  
Vol 3 (4) ◽  
pp. 117-131
Author(s):  
David Veale ◽  
Anna Stout
Keyword(s):  
Bipolar Disorder ◽  
Side Effects ◽  
Emotional Disorders ◽  
Cognitive Behaviour Therapy ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Underlying Disorder

AbstractThis article provides an overview of the role of psychopharmacotherapy in common emotional disorders for cognitive behaviour therapists. We consider some of the philosophical difference between CBT and medication, when medication might interfere with CBT, when it may enhance outcome and when it might be safely discontinued. We highlight how to differentiate side-effects and symptoms of discontinuation of antidepressants from that of the underlying disorder. The scope of this article is confined to common emotional disorders and does not discuss the interaction of CBT with medication in, e.g. schizophrenia, bipolar disorder or dementia.

scholarly journals Pharmacological treatment of depression and bipolar disorder in children and adolescents

2010 ◽  
Vol 16 (6) ◽  
pp. 402-412 ◽  
Author(s):  
Bernadka Dubicka ◽  
Paul Wilkinson ◽  
Raphael G. Kelvin ◽  
Ian M. Goodyer
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Treatment Guidelines ◽  
Evidence Base ◽  
Current Treatment ◽  
Risks And Benefits ◽  
Treatment Of Depression ◽  
Increased Risk ◽  
Potential Risks ◽  
Considerable Morbidity

SummaryMajor depression and bipolar disorder in children and adolescents are serious conditions associated with considerable morbidity as well as increased risk of suicide. The treatment of depression in young people is currently controversial and this article reviews the evidence base and potential risks and benefits of antidepressants. Although the diagnosis of bipolar disorder is also controversial, medication is the first-line treatment of choice in cases that meet diagnostic criteria. The limited evidence base in children and adolescents is presented, along with current treatment guidelines. Despite the controversies in this field, this article concludes that medication remains an important part of the treatment approach for both disorders, although the risks and benefits of pharmacotherapy need to be carefully assessed in each patient.

Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study

2015 ◽  
Vol 28 (2) ◽  
pp. 75-84 ◽  
Author(s):  
Louise Bjørklund ◽  
Henriette Thisted Horsdal ◽  
Ole Mors ◽  
Søren Dinesen Østergaard ◽  
Christiane Gasse
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Tricyclic Antidepressants ◽  
Treatment Guidelines ◽  
Treatment Patterns ◽  
Central Research ◽  
Cross Sectional ◽  
Psychopharmacological Treatment ◽  
Research Register ◽  
Disorder Treatment

ObjectiveIn bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy.MethodsCohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest.ResultsWe identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants.ConclusionThe results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

scholarly journals Efficacy of Internet Delivered Cognitive Behaviour Therapy for Anxiety and Depression in People with Bipolar Disorder

2020 ◽  
Author(s):  
Olav Nielssen ◽  
Lauren Staples ◽  
Eyal Karin ◽  
Rony Kayrouz ◽  
Blake Dear ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Behaviour Therapy ◽  
Routine Care ◽  
Anxiety And Depression ◽  
Behaviour Therapy ◽  
Research Reporting ◽  
Cognitive Behaviour ◽  
Assessment And Treatment ◽  
Patient Health ◽  
Psychiatric Conditions

Abstract BackgroundMindSpot is a national digital mental health service providing free assessment and treatment for anxiety and depression. Mindspot services have been accessed by people with a broad range of psychiatric conditions, including people who report a diagnosis of bipolar disorder (BD). There is comparatively little research reporting the outcome of internet delivered cognitive behaviour therapy (iCBT) for the depressed phase of BD (BDd), including as part of routine care. MethodDemographic characteristics, baseline scores and treatment outcomes were examined for patients who reported taking Lithium and had entries in their clinic records confirming the diagnosis of BD. Results were compared to the clinic benchmarks. Outcomes were completion rates, patient satisfaction and changes in measures of psychological distress, depression and anxiety as measured by the Kessler-10 item (K-10), Patient Health Questionnaire 9 Item (PHQ-9), and Generalized Anxiety Disorder Scale 7 Item (GAD-7), respectively. ResultsA total of 21,745 people completed a MindSpot assessment between January 2013 and December 2019 and enrolled in a MindSpot treatment course. Of these, 124 reported that they were currently taking Lithium, of whom 83 had entries in their clinic records confirming a diagnosis of BD. Mean age of patients with confirmed BD was 43.8 years, compared to the clinic mean of 39.8 years. Their baseline symptom scores were higher than the benchmark. However, reductions in symptoms on the K-10, PHQ-9, and GAD-7 were large (effect sizes > 1.0 on all measures, percentage change between 32.4% and 40%), and lesson completion and satisfaction with the course were also high. ConclusionsMindSpot treatments were effective in treating anxiety and depression in people diagnosed with BD, and the outcomes were comparable to clinic benchmarks. Results suggest that the routine provision of iCBT can help overcome the under-use of evidence based psychological treatments of people with BDd.

scholarly journals M147. ABERRANT TIMING AND ODDBALL DETECTION IN SCHIZOPHRENIA: FINDINGS FROM A TIME DISCRIMINATION / ODDBALL FMRI STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Javier Goena ◽  
María Sol Garcés ◽  
Irene Alústiza ◽  
Miguel Fernández-Martínez ◽  
María Fernández-Seara ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Deficit ◽  
Bipolar Depression ◽  
Cognitive Profile ◽  
Salience Network ◽  
Time Processing ◽  
Time Discrimination ◽  
Brain Circuits ◽  
Fmri Study ◽  
The Brain

Abstract Background Schizophrenia (SZ) is associated with deficits in both temporal and salience processing. The underlying neurological dysfunctions in both processes, which are interrelated and share neuroanatomical bases, remain poorly understood. Our main objective is to examine the hypothesis that the dysfunction of the brain circuits involved in time and salience processing underlies the cognitive deficit of schizophrenia and, to a lesser extent, in bipolar disorder (BD). Methods 10 schizophrenia patients, 7 bipolar depression patients and 10 healthy volunteers carried out an original experimental test of TD/OD during fMRI brain scanning. All participants performed the MATRICS Consensus Cognitive Battery to assess their cognitive profile. Results We found that SZ patients showed hypoactivation in cortical and subcortical areas related both with time processing and Salience Network. The dysfunction observed during timing tasks partially coincided with deficiencies in Oddball tasks. Discussion A dysfunctional timing/salience detection network underlies the cognitive impairment observed in SZ but not in BD patients.

scholarly journals Efficacy of Internet Delivered Cognitive Behaviour Therapy for People in the Depressed Phase of Bipolar Disorder

2021 ◽  
Author(s):  
Olav Nielssen ◽  
Lauren Staples ◽  
Eyal Karin ◽  
rony kayrouz ◽  
Blake Dear ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Behaviour Therapy ◽  
Bipolar Depression ◽  
Routine Care ◽  
Completion Rates ◽  
Depression And Anxiety ◽  
Behaviour Therapy ◽  
Research Reporting ◽  
Cognitive Behaviour ◽  
Patient Health

Abstract BackgroundThere is little research reporting the outcome of internet delivered cognitive behaviour therapy (iCBT) for the depressed phase of bipolar disorder as part of routine care. MethodsDemographic information, baseline scores and treatment outcomes were examined for patients of MindSpot Clinic, a national iCBT service who reported taking Lithium and their clinic records confirming the diagnosis of bipolar disorder. Outcomes were completion rates, patient satisfaction and changes in measures of psychological distress, depression and anxiety measured by the Kessler-10 item (K-10), Patient Health Questionnaire 9 Item (PHQ-9), and Generalized Anxiety Disorder Scale 7 Item (GAD-7), compared to clinic benchmarks. ResultsOut of 21,745 people completed a MindSpot assessment and enrolled in a MindSpot treatment course in a 7 year period, 83 reported taking Lithium and had a confirmed a diagnosis of bipolar disorder. Reductions in symptoms were large on all measures (effect sizes > 1.0 on all measures, percentage change between 32.4% and 40%), and lesson completion and satisfaction with the course were also high. ConclusionsMindSpot treatments were effective in treating anxiety and depression in people diagnosed with bipolar, and suggest that the routine provision of iCBT can help overcome the under-use of evidence based psychological treatments of people with bipolar depression.

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