Bipolar disorder future

In addition to its acute actions, Li+ can reduce the frequency of manic or depressive episodes in the bipolar patient and therefore is considered a mood-stabilizing agent. Accordingly, patients with bipolar disorder are often maintained on low stabilizing doses of Li+ indefinitely as a prophylaxis to future mood disturbances. Antidepressant medications are required in addition to Li+ for the treatment of breakthrough depression. 

An emerging literature suggests that treatment of psychiatric illness may reduce the risk of developing SUD later in life. The findings are most dramatic for stimulant therapy of ADHD, as several studies have observed decreased SUD rates in children whose ADHD was treated with stimulants, compared to ADHD children who received no such treatment (Biederman et ah, 1999 Toney et ah, 1999 Molina et ah, 1999). There is also preliminary evidence that treatment of bipolar disorder can reduce future substance use (Wilens et ah, 2000). While these findings are encouraging, further research is needed to support the initial data and to... 

In four instances, the agency has invoked this rule at the time of approval of supplements for new indications for psychotropic drugs already approved for other psychiatric indications. It was noted in the approval letters for these supplements that, since the drugs in question would likely be used in children and/ or adolescents with the newly approved indications, the FDA required the sponsors of these products to conduct studies that would be pertinent to such use in the pediatric population. Since the products were ready for approval in adults, the FDA deferred the required pediatric studies to a future date. Alternatively, sponsors could make an argument for waiver of the requirement. The drug products and indications for which the FDA has required studies under the Pediatric Rule are as follows paroxetine for social anxiety disorder sertraline for post-traumatic stress disorder (PTSD) olanzapine for acute mania in bipolar disorder and fluoxetine in premenstrual dysphoric disorder (PMDD). 

The treatment of the major depressive disorders such as unipolar and bipolar depressions was initially considered to be uniform, ffowever, with psychopharmacological advances, it has been demonstrated that the patients with bipolar depression may be partially responsive, at least prophylactically responsive, to lithium therapy, whereas the patients with unipolar depression are not as responsive (Abou-Saleh 1992). In addition, the treatment of depression may contribute through serendipity to the confirmation of a subgroup of patients with a bipolar disorder referred to as bipolar II. These patients, following treatment with antidepressants, will switch over to a hypomanic or fully manic phase resulting from pharmacological mechanisms. Thus, another subgroup of the bipolar disorder may be identified in the future. 

In the future, no one will have to worry about the negative side of bipolar disorder because we will have found the genes responsible for the debilitating aspect of the afflictions, which should allow us to dampen the problematic symptoms while allowing individuals to retain their creative spark. 

Lithium has been proven effective for acute and prophylactic treatment of both manic and depressive episodes in patients with bipolar illness (American Psychiatric Association 2002). However, patients with rapid-cycling bipolar disorder (i.e., patients who experience four or more mood disorder episodes per year) have been reported to respond less well to lithium treatment (Dunner and Fieve 1974 Prien et al. 1984 Wehr et al. 1988). Lithium is also effective in preventing future depressive episodes in patients with recurrent unipolar depressive disorder (American Psychiatric Association 2002) and as an adjunct to antidepressant therapy in depressed patients whose illness is partially refractory to treatment with antidepressants alone (discussed in Chapter 2). Furthermore, hthium may be useful in maintaining remission of depressive disorders after electroconvulsive therapy (Coppen et al. 1981 Sackeim et al. 2001). Lithium also has been used effectively in some cases of aggression and behavioral dyscontrol. 

Maintenance and prophylaxis with lithium, and perhaps other mood stabilizers, favorably alters the longitudinal course of a bipolar disorder. Thus, efforts to enhance long-term compliance are a necessary part of any overall strategy. The incidence of adverse or toxic events is relatively low, and close attention to the more clinically relevant consequences can usually prevent serious sequelae ( 198).An issue of critical importance for future research is the potential efficacy of alternative maintenance medication for those who fail to respond adequately to acute or long-term lithium therapy. 

The mood stabilizer lithium was developed as the first treatment for bipolar disorder. It has definitely modified the long-term outcome of bipolar disorder because it not only treats acute episodes of mania, but it is the first psychotropic drug proven to have a prophylactic effect in preventing future episodes of illness. Lithium even treats depression in bipolar patients, although it is not so clear that it is a powerful antidepressant for unipolar depression. Nevertheless, it is used to augment antidepressants for treating resistant cases of unipolar depression. 

This chapter will explore the various drug treatments for psychotic disorders, with special emphasis on schizophrenia. Such treatments include not only conventional antipsychotic drugs but also the newer atypical antipsychotic drugs, which are rapidly replacing the older conventional agents. We will also take a look into the future at the drugs under development for psychosis, especially schizophrenia. Mood stabilizers for bipolar disorders were covered in Chapter 7. 

Serretti A, Mandelli L. 2008. The genetics of bipolar disorder Genome hot regions, genes, new potential candidates and future directions. Mol Psychiatry 13 742-771. 

Medications are the core feature in the treatment of bipolar disorder. Without their skillful application, there is little hope for a good result. However, the illness and its course, coupled with the current imperfections of medication, make the use of psychotherapy and other psychosocial interventions essential tools. Bipolar patients are faced with myriad issues and obstacles that have a profound impact on how they perceive themselves and their future (Table 3.24). 

Bipolar disorder (BAD, manic-depressive illness) is a severe and chronic illness, which is a major public health problem, in any given year affecting approximately 1-3% of the US population (Narrow et al., 2002). In the World Health Organization Global Burden of Disease study, BAD ranked sixth among all medical disorders in years of life lost to death or disability worldwide, and is projected to have a greater impact in the future (Murray and Lopez, 1996). 

Goldberg JE. Treatment guidelines current and future management of bipolar disorder. J Qin Psychiatry 2000 61(Suppl 13) 12-18. 

The general objectives of treating acute episodes, preventing future episodes, and restoring the client s functioning become the primary focus of treatment with clients who present with bipolar disorder symptoms. Use of medication becomes the front line of intervention with bipolar... 

Weller, E. B. (1995). Bipolar disorder in children Misdiagnosis, underdiagnosis, and future directions. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 709-715. 

Geller, B., Cooper, T.B., Zimerman, B., Frazier, J., Williams, M., Heath, J., and Warner, K. (1998) Lithium for prepubertal depressed children with family history predictors of future bipolarity a double-blind, placebo-controlled study. / Affect Disord, 51 165-175. 

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