Bipolar affective disorder, 1-50

Affective (mood) disorders are characterized by changes in mood. The most common manifestation is depression, arranging from mild to severe forms. Psychotic depression is accompanied by hallucinations and illusions. Mania is less common than depression. In bipolar affective disorder, depression alternates with mania. 

Few papers have looked at the economic implications of bipolar affective disorder. Most of the published studies look at direct medical costs over the course of a year. Industry-sponsored studies focus on the benefits of a new treatment over older treatments. However, factors individual to a particular patient are likely to be more important than the average cost of a particular treatment. These include selection of patients who are likely to respond to a particular treatment, and psychoeducation coupled with encouragement during follow-up and carefial monitoring, to avoid such expensive outcomes as ftill-blown relapse, serious toxicity or suicide. 

Vogt, I. R., Shimron-Abarbanell, D., Neidt, H. etal. (2000). Investigation ofthehuman serotonin 6 [5HT6] receptor gene in bipolar affective disorder and schizophrenia. Am. J. Med. Genet., 96,217-21. 

Outline the main types of unipolar and bipolar affective disorder, and describe their clinical symptoms. 

Wang, H. Y. and Friedman, E. Enhanced protein kinase C activity and translocation in bipolar affective disorder brains. Biol. Psych. 40 568-575,1996. 

Friedman, E., Hoau Yan, W., Levinson, D. et al. Altered platelet protein kinase C activity in bipolar affective disorder, manic episode. Biol Psych. 33 520-525,1993. 

Whatever the mechanism of action of Li+ in the treatment of bipolar affective disorder turns out to be, there is no doubt that the functions of one or more of the neurotransmitters and hormones are involved to some extent. Much of the published data on the effects of Li+ on these systems is equivocal or even contradictory, in many cases reflecting differences in the experimental procedures, in particular the levels of Li+ employed. Often, where it has been looked for, there are differences observed between the acute and chronic effects of Li+. Therefore, the therapeutic relevance of many of these Li+-induced effects is difficult to assess. 

Bipolar Affective Disorder. A class of disorders that features mood swings from great highs (mania) to great lows (depression). 

Lithium is commonly used for bipolar affective disorders. Lithium however has a narrow therapeutic index and high risk for toxicity (Groleau 1994). The use of loop diuretics or ACE-inhibitors significantly increases the risk of hospitalisation for lithium toxicity in the elderly (Juurlink et al. 2004). Treatment of elderly patients with lithium should be thoroughly monitored. 

In the bipolar affective disorders (BPADs), periods of normal mood are interspersed with episodes of mania, hypomania, mixed states, or depression. BPAD differs from MDD in that there is a bidirectional natnre to the mood swings and, for many patients, the rate of cycling is more rapid in BPAD than MDD. The phases of BPAD inclnde mania, hypomania, and depression, though mixed states, the simultaneous presentation of symptoms of both mania and depression, are common. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

Disorders that are characterised by changes in mood are known as affective disorders, which are depression and mania, now known as unipolar and bipolar affective disorders, respectively. Mood is considered to depend upon the concentration of an amine neurotransmitter in some parts of the brain. 

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