Bipolar disorder case study

In the case of carbamazepine the evidence suggests that its prophylactic efficacy is less than that of lithium (Greil and Kleindienst, 1999). For valproate there is no placebo-controlled evidence as yet to support its efficacy in the prophylaxis of bipolar disorder. The only large-scale study designed to elucidate this action was a failed trial in which neither lithium nor valproate was more effective than placebo in maintenance treatment over 2 years (Bowden et al, 2000). 

The relative absence of systematic studies of bipolar patients under age 18 forces clinicians to extrapolate data from adult studies. There are four major types of studies that provide information on subjects with bipolar disorder double-blind, placebo-controlled studies of patients with acute mania prospective open-label studies of patients with bipolar disorder (which includes mania, hypomania, manic symptoms, or bipolar NOS, people at risk for mania because of their family history, and those with a history of mania who are not currently manic) case series and anecdotal reports. 

Robertson, J.M., and Tanguay, P.E. (1997) Case study the use of melatonin in a boy with refractory bipolar disorder. J Am Acad Child Adolesc Psychiatry 36 822-825. 

Woolston, J.L. (1999) Case study carbamazepine treatment of juvenile-onset bipolar disorder. / Am Acad Child Adolesc Psychiatry 38 335-338. 

Virtually all anticonvulsants are or have been of interest for the treatment of bipolar disorder. However, the importance of controlled data cannot be understated. For example, gabapentin, an anticonvulsant that initially received much attention as a potential mood stabilizer, was compared with placebo and did not appear to stabilize mood (Frye et al. 2000 Pande et al. 2000). Similar negative results were seen with topiramate in placebo-controlled trials for the treatment of mania. Although these medications might be useful adjuncts in some patients, given the currently expanded pharmacopoeia of medications with positive controlled trial data in bipolar disorder, we do not recommend the primary use of agents that have only case reports as an evidence base or controlled studies with predominantly negative results. 

Some patients with bipolar disorder will need antidepressants. Although the switch rate into mania or induction of rapid cychng by antidepressants is controversial, these agents do appear to present a risk for some patients, often with devastating consequences. Therefore, when a patient with bipolar disorder is prescribed an antidepressant, it should only be in combination with a medication that has established antimanic properties. Controlled comparative data on the use of specific antidepressant drugs in the treatment of bipolar depression are sparse. Current treatment guidelines extrapolate from these few studies and rely heavily on anecdotal chnical experience. Overah, tricyclic antidepressants should be avoided when other viable treatment options exist. Electroconvulsive therapy should be considered in severe cases. 

On average, symptom severity diminishes by 50% every 5 years between the ages of 10 and 25 years (55, 56). Hyperactivity declines more quickly than impulsivity or inattentiveness. However, symptoms of the condition persist into adulthood in many cases. The strongest predictors of symptomatic persistence are psychiatric co-morbidity, particularly with conduct or bipolar disorder and a family history of ADHD or substance abuse ( 57). A prospective study followed up a cohort of patients older than 16 years old with persistent ADHD symptoms and an age-matched control group and found an 11-fold increase in ongoing ADHD symptoms, a nine-fold increase in antisocial personality disorder, and a four-fold increase in substance abuse ( 58). 

Bernstein GA, Hughes JR, Mitchell JE, Thompson T. Effects of narcotic antagonists on self-injurious behavior a single case study. J Am Acad Child Adolesc Psychiatry 1987 26 886-889. McDougle CJ, Holmes JP, Bronson MR, et al. Risperidone treatment of children and onset bipolar adolescents with pervasive developmental disorders a prospective, open label study. J Am Acad Child Adolesc Psychiatry 1997 36 685-693. 

The lifetime population prevalence of schizophrenia is about 1% (Gottesman, 1989). In a landmark transnational study, similar prevalence w as found for schizophrenia in Africa, Asia, Europe, and the Americas (lablensky and Sartorius, 1988). There is no influence of gender in schizophrenia, w ith w omen as likely to develop this condition as men. Males may have an earlier onset of illness, and a more severe course of illness. Some evidence suggests that the prevalence of schizophrenia may be decreasing over time, w ith few er new cases of the illness reported. The age at onset of schizophrenia is late teens to early tw enties. As in bipolar disorder, the onset of first symptoms after age 40 is rare. 

Conventional antipsychotics improve symptoms of hyperactivity and impulsivity, but may have negative effects on learning and cognitive functioning as well as extrapyramidal side effects (e.g., dystonia and tardive dyskinesia) that limit their usefulness. The atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone have been used to control severe aggression in refractory cases of ADHD, particularly if conduct disorder or bipolar disorder coexists. More studies are needed to clarify their place in therapy. ... 

The following case studies are of patients with Alzheimer s disease, Parkinson s disease, depression, bipolar disorder and epilepsy. 

These cases are supported by a study in 5 patients taking carbamazepine and risperidone for schizophrenia or bipolar disorders. The dose-normalised plasma level of risperidone and its active metabolite, 9-hydroxyrisp-eridone, were 68% and 64% lower, respectively, with carbamazepine, when compared to those with risperidone alone. Another study in 11 patients who had been taking risperidone for 2 to 68 weeks found that carbamazepine 200 mg twice daily for a week approximately halved the plasma levels of risperidone and its active moiety (risperidone plus 9-hy-droxy risperidone). ... 

Gau SS, Chao PF, Lin YJ, Chang CJ, Gau CS. The association between carbamazepine and valproate and adverse cutaneous drug reactions in patients with bipolar disorder a nested matched case-control study. J Clin Psychopharmacol 2008 28(5) 509-17. 

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