The role of electroconvulsive therapy in the treatment of bipolar disorder

2017 ◽  
Author(s):  
Roumen Milev
Keyword(s):  
Bipolar Disorder ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Bipolar Disorders ◽  
Seizure Threshold ◽  
Randomized Control Trials ◽  
Mixed States ◽  
Everyday Clinical Practice ◽  
Randomized Control

This chapter examines the use of electroconvulsive therapy (ECT) for treatment of patients with bipolar disorders. It briefly reviews the basics of ECT, stimulus parameters, placement of electrodes, and seizure threshold. The data for efficacy and tolerability of ECT for bipolar disorder, including mania, depression, mixed states, and across the lifespan is reviewed. Although there is a paucity of good-quality randomized studies, all available data, including case reports and naturalistic observations, support the use of ECT in this population, and reinforce the widespread use of ECT in everyday clinical practice. Good-quality randomized control trials are urgently needed to address numerous unanswered questions, in order to improve efficacy and reduce side-effect burden of one of the best treatments for bipolar disorder.

Psychological Treatments and Prevention in Bipolar Disorder - Recent Developments

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. Kuehner
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Disorders ◽  
Behavioural Therapy ◽  
Psychological Interventions ◽  
Cognitive Behavioural ◽  
Recent Developments ◽  
Social Rhythm ◽  
Future Work ◽  
High Risk Children

This contribution provides a systematic review on recent developments in psychological interventions for bipolar disorder. The main focus of research to date has investigated the role of different psychotherapeutic approaches (cognitive behavioural therapy, family focused therapy, interpersonal and social rhythm therapy, psychoeducation) as an adjunct to pharmacotherapy for remission and relapse prevention. The review will assess efficacy and effectiveness of these interventions, their common ingredients, limitations and predictors of outcome. It will further explore the potential role of psychological interventions for primary prevention of bipolar disorders in high risk children and adolescents. Suggestions will be made for future work in these areas.

Are Prophylactic Systemic Antibiotics Necessary with Nasal Packing? A Systematic Review

2017 ◽  
Vol 31 (4) ◽  
pp. 240-247 ◽  
Author(s):  
Jessica L. Lange ◽  
Erin H. Peeden ◽  
Scott P. Stringer
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Toxic Shock Syndrome ◽  
Prophylactic Antibiotics ◽  
Nasal Packing ◽  
Randomized Control Trials ◽  
Toxic Shock ◽  
Randomized Control ◽  
Systemic Antibiotics

Background The use of prophylactic systemic antibiotics with nasal packing has been a controversial topic. There are few evidence-based studies to determine the need for prophylactic systemic antibiotics. We performed a systematic literature review to determine the role of prophylactic systemic antibiotics with nasal packing in the prevention of toxic shock syndrome and local nasal infections. Objective The purpose of this study was to perform a systematic literature review to determine the role of prophylactic systemic antibiotics with nasal packing in the prevention of toxic shock syndrome and local nasal infections. Methods A search for studies that reviewed the efficacy of prophylactic systemic antibiotics in the prevention of toxic shock or nasal infections and/or sinusitis for patients with nasal packing for epistaxis and postoperative septoplasties was performed. This was conducted in a number of medical literature data bases by following the methods of the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only English publications and human studies that were randomized control trials, quasi-randomized control trials, controlled clinical trials, retrospective studies, and case series were included. Results Six studies, with a total of 990 patients, met the inclusion criteria for the review and were included. Primary outcomes were signs and symptoms of nasal or sinus infections in patients who underwent nasal packing for epistaxis or septoplasty. There were no reports of toxic shock syndrome in any patients, and there was no statistical difference in purulent drainage in patients who had septoplasty (9.9 versus 11.2%) treated with or without antibiotics. Conclusion There is a paucity of literature that reviewed the need for prophylactic systemic antibiotics with nasal packing. The available literature does not show a significant benefit to the use of antibiotics with nasal packing, but the studies were underpowered to detect such a difference. One must consider the associated risks of prophylactic antibiotics to the patient as well when deciding to prescribe prophylactic antibiotics.

scholarly journals The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features

2017 ◽  
Vol 15 (3) ◽  
pp. 359-371 ◽  
Author(s):  
Giulio Perugi ◽  
Pierpaolo Medda ◽  
Cristina Toni ◽  
Michela Mariani ◽  
Chiara Socci ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Electroconvulsive Therapy ◽  
Mixed State ◽  
Bipolar Depression

scholarly journals Evaluation of the Role of ABCB1gene Polymorphic Variants on Psychiatric Disorders Predisposition in Macedonian Population

PRILOZI ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 71-88
Author(s):  
Zorica Naumovska ◽  
Aleksandra K. Nestorovska ◽  
Zoran Sterjev ◽  
Ana Filipce ◽  
Aleksandra Grozdanova ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Psychiatric Illness ◽  
Cell Activation ◽  
Bipolar Disorders ◽  
Control Group ◽  
Microglia Cell ◽  
Increased Risk ◽  
And Function

Abstract The psychiatric and other CNS disorders are characterized with unregulated neuro-inflammatory processes and chronic microglia cell activation resulting with detrimental effect. ABCB1gene polymorphismsC1236T, G2677T/Aand C3435T are associated with P-glycoprotein expression and function andare linked with predisposition to psychiatric disorders such as schizophrenia and bipolar disorders. The relationship between mood disorders and glucocorticoids has been confirmed and ABCB1 SNPs influence the glucocorticoids access to the brain. The aim of the study is evaluation of the influence of the three most common ABCB1SNPs on predisposition to psychiatric disorders in Macedonian population. In the study 107 unrelated healthy Macedonians of both sexes were enrolled as a control group and patient population of 54 patients (22 to 65 years old) diagnosed with schizophrenia or bipolar disorder. ABCB1 for three polymorphisms were analyzed by Real-Time PCR in both groups. The results have confirmed the role of the ABCB1 gene in predisposition to psychiatric disorders and increased risk of developing bipolar disorder in carriers of the heterozygotes and mutant homozygotes for polymorphic variations in 1236 and 2677 in comparison to the normal genotype carriers. Three-fold higher risk was estimated for psychiatric illness in women that are 1236 and 2677 heterozygous carrier (heterozygous and mutant homozygous) compared to healthy control (men and women) population and four-fold higher risk in comparison only to healthy women population. Mutant allele carriers for 1236 and 2677 polymorphisms that are 35 years and below in patients population have almost three-fold higher risk for development of psychiatric illness.

Suicide in Bipolar Disorder: Risks and Management

CNS Spectrums ◽  
2006 ◽  
Vol 11 (6) ◽  
pp. 465-471 ◽  
Author(s):  
Ross J. Baldessarini ◽  
Maurizio Pompili ◽  
Leonardo Tondo
Keyword(s):  
Bipolar Disorder ◽  
Clinical Supervision ◽  
Bipolar Disorders ◽  
Psychosocial Interventions ◽  
Suicidal Risk ◽  
Mixed States ◽  
Short Term ◽  
Lower Ratio ◽  
Population Rate

ABSTRACTBipolar disorders are prevalent, often severe, and disabling illnesses with elevated lethality largely due to suicide. Suicide rates average ∼1% annually, or perhaps 60 times higher than the international population rate of 0.015% annually. Suicidal acts typically occur early in bipolar disorders and in association with severe depressive or mixed states. The high lethality of suicidal acts in bipolar disorders is suggested by a much lower ratio of attempts:suicide (∼3:1) than in the general population (∼30:1). Risk factors can help to identify patients at increased suicidal risk, but ongoing clinical assessment is essential to limit risk. Empirical short-term interventions to manage acute suicidal risk include close clinical supervision, rapid hospitalization, and electroconvulsive therapy. Remarkably, however, evidence of the long-term effectiveness of most treatments against suicidal behavior is rare. A notable exception is lithium prophylaxis, which is associated with consistent evidence of major (∼80%), sustained relative reductions of risk of suicides and attempts, and lower lethality (increased attempts:suicide ratio). Such benefits are unproved for other treatments commonly used to treat bipolar disorder patients, including anticonvulsants, antipsychotics, antidepressants, and psychosocial interventions. Applying available knowledge systematically, with close and sustained clinical supervision, can enhance management of suicidal risk in bipolar disorders patients.

Lamotrigine for the Treatment of Bipolar Disorder

2000 ◽  
Vol 34 (2) ◽  
pp. 258-262 ◽  
Author(s):  
Patricia M Engle ◽  
Amy M Heck
Keyword(s):  
Bipolar Disorder ◽  
Clinical Efficacy ◽  
Case Reports ◽  
Controlled Trial ◽  
Current Data ◽  
Stabilizing Agents ◽  
Treatment Refractory

OBJECTIVE: To describe the available data regarding the clinical efficacy of lamotrigine for the treatment of bipolar disorder. SUMMARY: Anticonvulsants have emerged as alternative mood-stabilizing agents for patients with bipolar disorder who do not respond to lithium. Data regarding the efficacy of lamotrigine have been generated primarily from case reports, small open trials, and one large, randomized, placebo-controlled trial. These reports suggest that lamotrigine may be effective for the management of bipolar disorder. CONCLUSIONS: Although current data are limited, treatment-refractory patients with bipolar disorder may benefit from lamotrigine therapy. Several studies are currently underway to determine the appropriate role of lamotrigine in the treatment of bipolar disorder.

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