Baseline

Rapid Cycling ◽

Treatment Interval ◽

Behavior Plans ◽

Medicating Children

This chapter describes electroconvulsive therapy (ECT) that stabilized Jonah's rapid-cycling bipolar disorder in 2010 after exhaustive medication trials, elaborate behavior plans, and a ten-month hospitalization failed. It details how Jonah experiences mild episodes of agitation with no obvious environmental triggers toward the end of the treatment interval. It also analyses the term “baseline,” which refers to an original, predisease state. The chapter describes Jonah's treatments that were therapeutic to the extent they restored optimal, baseline functioning. It discusses opponents of medicating children that are fierce and pervasive, such as in books with ominous titles like The Silenced Child and Suffer the Children, and certain articles featured on well-respected platforms.

Effectiveness of Maintenance Electroconvulsive Therapy in Rapid-Cycling Bipolar Disorder

Journal of Ect ◽

10.1097/yct.0b013e3181dbf797 ◽

2011 ◽

Vol 27 (2) ◽

pp. 123-126 ◽

Cited By ~ 20

Author(s):

Gian Paolo Minnai ◽

Pier Giorgio Salis ◽

Rosanna Oppo ◽

Anna Paola Loche ◽

Filomena Scano ◽

...

Keyword(s):

Bipolar Disorder ◽

Post–Electroconvulsive Therapy Status Epilepticus and Tardive Seizure in a Patient With Rapid Cycling Bipolar Disorder, Epilepsy, and Intellectual Disability

Journal of Ect ◽

10.1097/yct.0b013e318248e1fb ◽

2012 ◽

Vol 28 (3) ◽

pp. 183-184 ◽

Cited By ~ 5

Author(s):

Saji Joseph Chathanchirayil ◽

Ravi Bhat

Keyword(s):

Bipolar Disorder ◽

Intellectual Disability ◽

Status Epilepticus ◽

Successful treatment with maintenance electroconvulsive therapy for a patient with medication-resistant rapid cycling bipolar disorder

Psychiatry and Clinical Neurosciences ◽

10.1111/j.1440-1819.2011.02195.x ◽

2011 ◽

Vol 65 (3) ◽

pp. 299-300 ◽

Cited By ~ 1

Author(s):

Kaichiro Amino ◽

Shigemasa Katayama ◽

Makio Iimori

Keyword(s):

Bipolar Disorder ◽

Successful Treatment ◽

Efficacy of Electroconvulsive Therapy in Continuous Rapid Cycling Bipolar Disorder

Psychiatric Annals ◽

10.3928/0048-5713-19991201-04 ◽

1999 ◽

Vol 29 (12) ◽

pp. 679-683 ◽

Cited By ~ 1

Author(s):

Edward A Wolpert ◽

Valentin Berman ◽

Myron Bornstein

Keyword(s):

Bipolar Disorder ◽

Electroconvulsive Therapy (ECT) in Bipolar Disorder Patients with Ultra-Rapid Cycling and Unstable Mixed States

Medicina ◽

10.3390/medicina57060624 ◽

2021 ◽

Vol 57 (6) ◽

pp. 624

Author(s):

Sergey Mosolov ◽

Christoph Born ◽

Heinz Grunze

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Mood Stabilizer ◽

Rapid Cycling ◽

Mixed States ◽

Limited Effectiveness ◽

Bipolar Patients ◽

Depressive Episodes

Background and Objectives: Unstable mixed episodes or rapid switching between opposite affective poles within the scope of short cycles was first characterized in 1967 by S. Mentzos as complex polymorphous states with chaotic overlap of manic and depressive symptoms. Well-known examples include antidepressant-induced mania/hypomania and rapid/ultra-rapid/ultradian cycling, when clinicians observe an almost continuous mixed state with a constant change of preponderance of manic or depressive symptoms. Achieving stable remission in these cases is challenging with almost no data on evidence-based treatment. When mood stabilizers are ineffective, electroconvulsive therapy (ECT) has been suggested. Objectives: After reviewing the evidence from available literature, this article presents our own clinical experience of ECT efficacy and tolerability in patients with ultra-rapid cycling bipolar disorder (BD) and unstable mixed states. Materials and Methods: We conducted an open, one-year observational prospective study with a “mirror image” design, including 30 patients with rapid and ultra-rapid cycling BD on long-term mood stabilizer treatment (18 received lithium carbonate, 6 on valproate and 6 on carbamazepine) with limited effectiveness. A bilateral ECT course (5–10 sessions) was prescribed for regaining mood stability. Results: ECT was very effective in 12 patients (40%) with a history of ineffective mood stabilizer treatment who achieved and maintained remission; all of them received lithium except for 1 patient who received carbamazepine and 2 with valproate. Nine patients (30%) showed partial response (one on carbamazepine and two on valproate) and nine patients (30%) had no improvement at all (four on carbamazepine and two on valproate). For the whole sample, the duration of affective episodes was significantly reduced from 36.05 ± 4.32 weeks in the year prior to ECT to 21.74 ± 12.14 weeks in the year post-ECT (p < 0.001). Depressive episodes with mixed and/or catatonic features according to DSM-5 specifiers were associated with a better acute ECT response and/or long-term mood stabilizer treatment outcome after ECT. Conclusions: ECT could be considered as a useful option for getting mood instability under control in rapid and ultra-rapid cycling bipolar patients. Further randomized trials are needed to confirm these results.

Gambling problems in bipolar disorder in the UK: Prevalence and distribution

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.154286 ◽

2015 ◽

Vol 207 (4) ◽

pp. 328-333 ◽

Cited By ~ 19

Author(s):

Lisa Jones ◽

Alice Metcalf ◽

Katherine Gordon-Smith ◽

Liz Forty ◽

Amy Perry ◽

...

Keyword(s):

Bipolar Disorder ◽

Problem Gambling ◽

Severity Index ◽

Gambling Problems ◽

Rapid Cycling ◽

Probable Significance ◽

History Of ◽

Gambling Severity ◽

The Uk

BackgroundNorth American studies show bipolar disorder is associated with elevated rates of problem gambling; however, little is known about rates in the different presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling in people with bipolar disorder in the UK.MethodThe Problem Gambling Severity Index was used to measure gambling problems in 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in people with bipolar disorder than in the general population, and were associated with type 2 disorder (OR = 1.74, P = 0.036), history of suicidal ideation or attempt (OR = 3.44, P = 0.02) and rapid cycling (OR = 2.63, P = 0.008).ConclusionsApproximately 1 in 10 patients with bipolar disorder may be at moderate to severe risk of problem gambling, possibly associated with suicidal behaviour and a rapid cycling course. Elevated rates of gambling problems in type 2 disorder highlight the probable significance of modest but unstable mood disturbance in the development and maintenance of such problems.

New data on the use of lithium, divalproate, and lamotrigine in rapid cycling bipolar disorder

European Psychiatry ◽

10.1016/j.eurpsy.2004.12.003 ◽

2005 ◽

Vol 20 (2) ◽

pp. 92-95 ◽

Cited By ~ 32

Author(s):

JR Calabrese ◽

DJ Rapport ◽

EA Youngstrom ◽

K. Jackson ◽

S. Bilali ◽

...

Keyword(s):

Bipolar Disorder ◽

Unmet Need ◽

Depressive Illness ◽

Term Treatment ◽

Rapid Cycling ◽

Double Blind ◽

Parallel Group Design ◽

Parallel Group ◽

Long Term Treatment ◽

Current Therapies

AbstractThe rapid cycling variant of bipolar disorder is defined as the occurrence of four periods of either manic or depressive illness within 12 months. Patients suffering from this variant of bipolar disorder have an unmet need for effective treatment. This review examines two major studies in an attempt to update understanding of the current therapies available to treat rapid cycling patients. The first trial compares lamotrigine versus placebo in 182 patients studied for 6 months. The second is a recently completed, 20-month trial comparing divalproate and lithium in 60 patients. Both trials had a double-blind, randomized parallel-group design. The data from the latter study indicate that there are no large differences in efficacy between lithium and divalproate in the long-term treatment of rapid cycling bipolar disorder. In addition, lamotrigine has the potential to complement the spectrum of lithium and divalproate through its greater efficacy for depressive symptoms.