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Adult Psychiatric Unit: Bipolar Disorder

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By Edwin Kim Resident Physician, Aspiring Addiction Psychiatrist
Markku Lähteenvuo, Antti Tanskanen, Heidi Taipale, Fabian Hoti, Pia Vattulainen, Eduard Vieta, Jari Tiihonen
Importance: Mood stabilizers and antipsychotics are the main maintenance treatments for bipolar disorder. Lithium is considered to be the most effective mood stabilizer, but very little is known about overall health outcomes associated with specific treatments and the comparative long-term effectiveness of specific psychotropics or routes of administration in the prevention of rehospitalizations. Objective: To study the comparative effectiveness of pharmacologic treatments in the prevention of rehospitalization in a nationwide cohort of patients with bipolar disorder...
February 28, 2018: JAMA Psychiatry
Eduard Vieta, Estela Salagre, Iria Grande, André F Carvalho, Brisa S Fernandes, Michael Berk, Boris Birmaher, Mauricio Tohen, Trisha Suppes
Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the outcome of the illness and avert potentially irreversible harm to patients with bipolar disorder, as early phases may be more responsive to treatment and may need less aggressive therapies...
January 24, 2018: American Journal of Psychiatry
William V Bobo
Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness...
October 2017: Mayo Clinic Proceedings
Jie Song, Arvid Sjölander, Erik Joas, Sarah E Bergen, Bo Runeson, Henrik Larsson, Mikael Landén, Paul Lichtenstein
OBJECTIVE: Conclusions regarding lithium's antisuicidal effect for bipolar disorder have been limited due to nonrepresentative subjects and potential confounding factors, including varying severity of illness. Findings regarding the effect of valproate, the most common alternative to lithium, are inconsistent for suicidal behavior. This study investigated the associations of these two drugs with the risk of suicide-related events, and possible differences between drugs, by using within-individual designs in a register-based longitudinal cohort...
August 1, 2017: American Journal of Psychiatry
M G Carta, J Angst
INTRODUCTION: Bipolar disorder (BD) is a public health issue; it is one of the leading causes of disability and its late diagnosis heightens the impact of the condition. Screening tools for early detection could be extremely useful. METHODS: Narrative review on screening of BD. RESULTS: Screening questionnaires have high sensitivity but relatively low specificity if DSM diagnoses are taken as the "gold standard". Critics maintain that an excess of false positives makes such tools unnecessary for identifying cases and of little use in screening studies consisting of two phases...
November 15, 2016: Journal of Affective Disorders
Ihsan M Salloum, Edson Sherwood Brown
BACKGROUND: The comorbidity of substance use disorders (SUDs) in bipolar disorder is among the highest in psychiatric disorders. Evidence-based controlled psychosocial or pharmacological interventions trials, which may guide treatment decisions, have not been systematically reviewed. OBJECTIVE: To present a narrative review of the public health and clinical significance of this condition, including diagnostic and treatment implications, and to evaluate controlled trials conducted to date...
July 2017: American Journal of Drug and Alcohol Abuse
Johanna E M P Smits, Eveline Wallenburg, Arno van Spanje, Matthijs van Luin, Radboud M Marijnissen
No abstract text is available yet for this article.
April 2017: Journal of Clinical Psychiatry
Lori L Altshuler, Catherine A Sugar, Susan L McElroy, Brian Calimlim, Michael Gitlin, Paul E Keck, Ana Aquino-Elias, Brian E Martens, E Grace Fischer, Teri L English, Janine Roach, Trisha Suppes
OBJECTIVE: The authors compared medication-induced mood switch risk (primary outcome), as well as treatment response and side effects (secondary outcomes) with three acute-phase treatments for bipolar II depression. METHOD: In a 16-week, double-blind, multisite comparison study, 142 participants with bipolar II depression were randomly assigned to receive lithium monotherapy (N=49), sertraline monotherapy (N=45), or combination treatment with lithium and sertraline (N=48)...
March 1, 2017: American Journal of Psychiatry
Erik Joas, Alina Karanti, Jie Song, Guy M Goodwin, Paul Lichtenstein, Mikael Landén
BackgroundClinical trials have examined the efficacy of drugs to prevent relapse in patients with bipolar disorder, however, their design often limits generalisation to routine clinical practice.AimsTo estimate the effectiveness of drugs used for maintenance treatment in bipolar disorder.MethodWe used national registers to identify 35 022 individuals diagnosed with bipolar disorder and information on lithium, valproate, carbamazepine, lamotrigine, quetiapine and olanzapine treatment from 2006 to 2009. The main outcome was psychiatric hospital admissions...
March 2017: British Journal of Psychiatry: the Journal of Mental Science
İzgi Alnıak, Murat Erkıran, Elif Mutlu
BACKGROUND: To determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD). METHODS: A sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS)...
March 15, 2016: Journal of Affective Disorders
Alexander Viktorin, Eleonore Rydén, Michael E Thase, Zheng Chang, Cecilia Lundholm, Brian M D'Onofrio, Catarina Almqvist, Patrik K E Magnusson, Paul Lichtenstein, Henrik Larsson, Mikael Landén
OBJECTIVE: The authors sought to determine the risk of treatment-emergent mania associated with methylphenidate, used in monotherapy or with a concomitant mood-stabilizing medication, in patients with bipolar disorder. METHOD: Using linked Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The cohort was divided into two groups: those with and those without concomitant mood-stabilizing treatment...
April 1, 2017: American Journal of Psychiatry
Ekkehard Othmer, Cherilyn M Desouza, Elizabeth C Penick, Elizabeth J Nickel, Edward E Hunter, Sieglinde C Othmer, Barbara J Powell, Sandra B Hall
OBJECTIVE: Previous prospective studies have shown that unipolar depressed patients often switch to a manic episode. Some of these studies have reported that the conversion to bipolar disorder is predicted by an early onset of depression, a positive family history for mania, and psychotic symptoms. The present study examines the strength of the relationship between these 3 indicators, both alone and in combination, and the presence of mania in a large retrospective analysis. METHOD: 1458 consecutive admissions to a large, Midwestern university outpatient clinic between 1981 and 1986 were interviewed, and 1002 patients met DSM-III inclusive criteria for major depressive disorder...
January 2007: Journal of Clinical Psychiatry
Haley G Gibbs, David E Zimmerman, Kenneth M Shermock, William Clarke, Marek A Mirski, John J Lewin
PURPOSE: The differences in free fraction serum valproic acid concentrations between inpatients and outpatients were compared, and factors associated with therapeutic discordance were evaluated. METHODS: This retrospective, single-center, cross-sectional study included patients with both a free and a total valproic acid concentration drawn within 30 minutes of each other between January 7, 2003, and June 1, 2011. Serum valproic acid concentrations were stratified by admission status (inpatient versus outpatient)...
January 15, 2015: American Journal of Health-system Pharmacy: AJHP
Swetha Reddy Damegunta
No abstract text is available yet for this article.
July 2014: Indian Journal of Psychological Medicine
S Nassir Ghaemi, William S Gilmer, Joseph F Goldberg, Benjamin Zablotsky, David E Kemp, Mary E Kelley, Amber D Bauer, Jenelle Fleck, Megan M Filkowski, Vanessa A Stan, Robert T Dunn
OBJECTIVE: To determine the efficacy of divalproex (extended release) in the treatment of acute nonrefractory bipolar depression. METHOD: In a stratified, double-blind, randomized, placebo-controlled trial, 18 acutely depressed bipolar outpatients (DSM-IV criteria) received either divalproex monotherapy (target dose level, 70-90 ng/dL) (N = 9) or placebo (N = 9) for 6 weeks. Patients were recruited between January 2004 and May 2005. Clinical assessment on the Montgomery-Asberg Depression Rating Scale (MADRS) determined primary efficacy...
December 2007: Journal of Clinical Psychiatry
Noreen A Reilly-Harrington, Richard C Shelton, Masoud Kamali, Dustin J Rabideau, Leah W Shesler, Madhukar H Trivedi, Susan L McElroy, Louisa G Sylvia, Charles L Bowden, Terence A Ketter, Joseph R Calabrese, Michael E Thase, William V Bobo, Thilo Deckersbach, Mauricio Tohen, Melvin G McInnis, James H Kocsis, Alexandra K Gold, Vivek Singh, Daniel M Finkelstein, Gustavo Kinrys, Andrew A Nierenberg
BACKGROUND: Few brief, self-report measures exist that can reliably predict adverse suicidality outcomes in patients with BD. This study utilized the Concise Health Risk Tracking Self-Report (CHRT) to assess suicidality in patients with BD and examined its psychometric performance, clinical correlates, and prospective value in predicting adverse events related to suicidality. METHODS: The CHRT was administered at baseline and follow-up to 482 adult patients in Bipolar CHOICE, a 6-month randomized comparative effectiveness trial...
March 1, 2016: Journal of Affective Disorders
Joseph F Goldberg, Marlene P Freeman, Richard Balon, Leslie Citrome, Michael E Thase, John M Kane, Maurizio Fava
BACKGROUND: Optimal successive treatment decisions are not well established after an initial medication nonresponse in major depressive disorder or bipolar disorder. While practice guidelines offer consensus-based expert treatment recommendations, little is known about "real world" pharmacology decision making by practicing psychopharmacologists. MATERIALS AND METHODS: We surveyed via Internet the national membership of the American Society of Clinical Psychopharmacology (ASCP) to study preferred pharmacotherapy strategies and factors that influence medication choices for patients with mood disorders...
August 2015: Depression and Anxiety
Joseph F Goldberg, Roy H Perlis, S Nassir Ghaemi, Joseph R Calabrese, Charles L Bowden, Stephen Wisniewski, David J Miklowitz, Gary S Sachs, Michael E Thase
OBJECTIVE: Practice guidelines have advised against treating patients with antidepressants during bipolar mixed states or dysphoric manias. However, few studies have examined the outcomes of patients with co-occurring manic and depressive symptoms who are treated with antidepressants plus mood stabilizing drugs. METHOD: The authors compared outcomes in patients with bipolar disorder who received a mood stabilizing agent with versus without an antidepressant for a bipolar depressive episode accompanied by > or = 2 concurrent manic symptoms...
September 2007: American Journal of Psychiatry
Roy H Perlis, Michael J Ostacher, Joseph F Goldberg, David J Miklowitz, Edward Friedman, Joseph Calabrese, Michael E Thase, Gary S Sachs
Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode...
December 2010: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Isabella Pacchiarotti, David J Bond, Ross J Baldessarini, Willem A Nolen, Heinz Grunze, Rasmus W Licht, Robert M Post, Michael Berk, Guy M Goodwin, Gary S Sachs, Leonardo Tondo, Robert L Findling, Eric A Youngstrom, Mauricio Tohen, Juan Undurraga, Ana González-Pinto, Joseph F Goldberg, Ayşegül Yildiz, Lori L Altshuler, Joseph R Calabrese, Philip B Mitchell, Michael E Thase, Athanasios Koukopoulos, Francesc Colom, Mark A Frye, Gin S Malhi, Konstantinos N Fountoulakis, Gustavo Vázquez, Roy H Perlis, Terence A Ketter, Frederick Cassidy, Hagop Akiskal, Jean-Michel Azorin, Marc Valentí, Diego Hidalgo Mazzei, Beny Lafer, Tadafumi Kato, Lorenzo Mazzarini, Anabel Martínez-Aran, Gordon Parker, Daniel Souery, Ayşegül Ozerdem, Susan L McElroy, Paolo Girardi, Michael Bauer, Lakshmi N Yatham, Carlos A Zarate, Andrew A Nierenberg, Boris Birmaher, Shigenobu Kanba, Rif S El-Mallakh, Alessandro Serretti, Zoltan Rihmer, Allan H Young, Georgios D Kotzalidis, Glenda M MacQueen, Charles L Bowden, S Nassir Ghaemi, Carlos Lopez-Jaramillo, Janusz Rybakowski, Kyooseob Ha, Giulio Perugi, Siegfried Kasper, Jay D Amsterdam, Robert M Hirschfeld, Flávio Kapczinski, Eduard Vieta
OBJECTIVE: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. METHOD: An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method...
November 2013: American Journal of Psychiatry
2016-02-06 17:55:38
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