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Adult Psychiatric Unit: Bipolar Disorder

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By Edwin Kim Resident Physician, Aspiring Addiction Psychiatrist
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)...
January 31, 2017: American Journal of Psychiatry
Erik Joas, Alina Karanti, Jie Song, Guy M Goodwin, Paul Lichtenstein, Mikael Landén
BACKGROUND: Clinical 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. AIMS: To estimate the effectiveness of drugs used for maintenance treatment in bipolar disorder. METHOD: We 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...
January 19, 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...
October 3, 2016: 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
Thomas Scheidemantel, Irina Korobkova, Soham Rej, Martha Sajatovic
Asenapine (Saphris(®)) is an atypical antipsychotic drug which has been approved by the US Food and Drug Administration for the treatment of schizophrenia in adults, as well as the treatment of acute manic or mixed episodes of bipolar I in both adult and pediatric populations. Asenapine is a tetracyclic drug with antidopaminergic and antiserotonergic activity with a unique sublingual route of administration. In this review, we examine and summarize the available literature on the safety, efficacy, and tolerability of asenapine in the treatment of bipolar disorder (BD)...
2015: Neuropsychiatric Disease and Treatment
J Sloan Manning
Managing patients with bipolar disorder remains a challenge due to its chronic nature. In addition, bipolar depression remains understudied even though patients spend more time in depressive episodes than in manic ones. Effective treatment requires an accurate and timely diagnosis, psychoeducation, psychotherapy, pharmacotherapy, and implementation of elements of the chronic care model. Pharmacologic strategies for treating bipolar depression differ from those for bipolar mania as well as those for unipolar depression and require knowledge of the efficacy and safety of agents including mood stabilizers, atypical antipsychotics, and antidepressants both as monotherapy and in combination...
November 2015: Journal of Clinical Psychiatry
J Sloan Manning
Patients with bipolar disorder require diligent management involving psychoeducation, a strong therapeutic alliance, and ongoing monitoring with rating scales to achieve the best outcomes. Clinicians should monitor symptom response, functioning, and quality of life to determine if treatment needs to be be adjusted. Assessing adverse effects must be done regularly to improve treatment adherence. Because effective acute phase treatments are often continued in maintenance treatment, clinicians must find the right balance of efficacy and tolerability for long-term success...
December 2015: Journal of Clinical Psychiatry
E Hollander
Obsessive-compulsive disorder (OCD) is one of the most common psychiatric disorders, occurring in 2% to 3% of the U.S. population. Borderline personality disorder is found in 2% of the U.S. population. These disorders denote the endpoints on a spectrum of compulsive and impulsive disorders. One endpoint marks compulsive or risk-aversive behaviors characterized by overestimation of the probability of future harm, highlighted by OCD. The other endpoint designates impulsive action characterized by the lack of complete consideration of the negative results of such behavior, such as borderline and antisocial personality disorders...
1999: Journal of Clinical Psychiatry
Trisha Suppes, Robert Silva, Josephine Cucchiaro, Yongcai Mao, Steven Targum, Caroline Streicher, Andrei Pikalov, Antony Loebel
OBJECTIVE: Accumulating evidence indicates that manic symptoms below the threshold for hypomania (mixed features) are common in individuals with major depressive disorder. This form of depression is often severe and is associated with an increased risk for recurrence, suicide attempts, substance abuse, and functional disability. This study evaluated the efficacy and safety of lurasidone in major depressive disorder with mixed features. METHODS: Patients meeting DSM-IV-TR criteria for major depressive disorder who presented with two or three protocol-defined manic symptoms were randomly assigned to 6 weeks of double-blind treatment with either lurasidone at 20-60 mg/day (N=109) or placebo (N=100)...
April 1, 2016: American Journal of Psychiatry
Iria Grande, Michael Berk, Boris Birmaher, Eduard Vieta
Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression...
April 9, 2016: Lancet
Richard Wesseloo, Astrid M Kamperman, Trine Munk-Olsen, Victor J M Pop, Steven A Kushner, Veerle Bergink
OBJECTIVE: Women with a history of bipolar disorder, postpartum psychosis, or both are at high risk for postpartum relapse. The aim of this meta-analysis was to estimate the risk of postpartum relapse in these three patient groups. METHOD: A systematic literature search was conducted in all public medical electronic databases, adhering to the PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with bipolar disorder and/or a history of postpartum psychosis or mania according to DSM or ICD criteria or the Research Diagnostic Criteria...
February 1, 2016: American Journal of Psychiatry
2015-11-06 04:35:58
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