Bipolar disorder types

Major depressive disorder, recurrent Bipolar disorder, type I ... 

Bipolar disorder, type llc Dysthymic disorder Cyclothymic disorder ... 

Although mania has been associated with olanzapine (SEDA-24, 68 SEDA-25, 68 SEDA-26, 62), it has also been used in the treatment of acute mania. In a 12-week, double-blind, double-dummy, randomized trial, 120 patients with bipolar disorder type I hospitalized for an acute manic episode were randomly assigned to either sodium valproate (n = 63) or olanzapine (n = 57) and were followed in hospital for up to 21 days (60). Valproate and olanzapine had similar short-term effects on clinical or health-related quality of life outcomes in bipolar disorder adverse effects that occurred in a higher percentage of olanzapine-treated than valproate-treated patients included somnolence (47% versus 29%), weight gain (25% versus 10%), rhinitis (14% versus 3%), edema (14% versus 0%), and slurred speech (7% versus 0%) no adverse events occurred significantly more often with valproate. 

A 50-year-old woman with a history of bipolar disorder type I and alcohol dependence taking disulfiram had a 4-day history of a change in mental status, including visual hallucinations and deficits in orientation and... 

Brauuou GE, RoUaud PD. Auorgasmia iu a patient with bipolar disorder type 1 treated with gabapentin. J Clin Psychopharmacol 2000 20(3) 379-81. 

Major depressive disorder, single episode Major depressive disorder, recurrent Bipolar disorder, type P Bipolar disorder, type lb Dysthymic disorder Cyclothymic disorder ... 

Other Drugs. Agents not considered to be CNS stimulants yet employed for the treatment of certain types of depression includes lithium carbonate for the treatment of bipolar disorder. In most patients, lithium is the sole agent used to control manic behavior and is very effective (see... 

Bipolar disorders have been categorized into bipolar I disorder, bipolar II disorder, and bipolar disorder, not otherwise specified (NOS). Bipolar I disorder is characterized by one or more manic or mixed mood episodes. Bipolar II disorder is characterized by one or more major depressive episodes and at least one hypomanic episode. Hypomania is an abnormally and persistently elevated, expansive, or irritable mood, but not of sufficient severity to cause significant impairment in social or occupational function and does not require hospitalization. Most epidemiologic studies have looked at bipolar disorder of all types (bipolar I and bipolar II), or the bipolar spectrum, which includes all clinical conditions thought to be closely related to bipolar disorder. The lifetime prevalence of bipolar I disorder is estimated to be between 0.3% and 2.4%. The lifetime prevalence of bipolar II disorder ranges from 0.2% to 5%. When including the bipolar spectrum, the lifetime prevalence is between 3% and 6.5%.1... 

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, classifies bipolar disorders as (1) bipolar I, (2) bipolar II, (3) cyclothymic disorder, and (4) bipolar disorder not otherwise specified. Table 69-3 defines mood disorders by type of episode. Table 69-4 describes the evaluation and diagnostic criteria for mood disorders. 

A great many physical and mental disorders develop because of a malfunction in the nervous system. Some examples are Alzheimer s disease, schizophrenia, Parkinson s disease, Huntington s chorea, and bipolar disorder. Most of the effects produced by recreational drugs, such as alcohol, heroin, and cocaine, are also a result of changes in the way the nervous system functions. Today, scientists have a reasonably good understanding of the way in which the nervous system operates and how many types of chemicals affect this operation. 

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. 

Carbamazepine produces complex effects in a variety of neurotransmitters, receptors, and second messenger and neuropeptide systems (Post et al. 1992, 1994a). Determining which of these effects is most closely associated with its psychotropic properties in bipolar disorder and which of these or other effects may be responsible for the augmentation response in combination therapy with dihydropyridine L-type CCBs remains to be further evaluated. However, discussion of two possibilities might be beneficial. One possibility, of course, is that actions of carbamazepine unrelated to calcium dynamics account for its augmenting effects with nimodipine. The plethora of these other... 

Mood stabilizers with antimanic and antidepressive efficacy, preventing affective episodes in different types of bipolar disorder from occurring, with considerably better tolerability than lithium. 

Chapter /, Modem Psychopharmaceuticals, written by Dr Hossein Fatemi, and Chapter 5, Psychopharmaceuticals and the Treatment of Mental Disorders, provide succinct, up to date, and well-referenced information on how to use the major classes of psychotropic drugs. The latter chapter discusses in a frank and balanced manner the ambivalence towards the use of pharmacologic agents in mental disorders felt by some, and the limitations on the achievements of current drugs as ideal therapies for schizophrenia, bipolar disorder and major depression in particular. Clearly, much has been accomplished, but many needs, especially for prevention of relapse, removal of specific types of symptoms, and restoraton of work and social function, remain to be accomplished by drug and psychosocial therapies. 

Bipolar disorder can be divided into primary and secondary types, with the latter developing as a consequence of various medical conditions or substances that can alter brain function or structure. This categorization underscores the view of mania as a syndrome subsequent to various pathophysiologies. 

One family study indicated that the schizoaffective-manic type tended to aggregate with classic bipolar disorder, while the schizoaffective-depressive type seemed to be more closely related to schizophrenia ( 37). 

The differentiation between the emotional vicissitudes of adolescence and more subtle episodes of bipolar disorder can be difficult. Nonetheless, a sizable minority (30%) of adult patients with bipolar disorder report having their first symptoms during adolescence. Furthermore, classic manic (type I) episodes have been observed during adolescence, and the earlier the onset, the more likely the patient will have a psychotic form ( H). Childhood-onset mania can be severe and is frequently co-morbid with ADFID and other psychiatric disorders (205). 

Because lithium shows some utility in certain patients whose dual diagnosis includes bipolar disorder, and because the anticonvulsants attenuate several types of withdrawal syndromes, these agents may be useful and safe for selected alcoholic patients with bipolar and related disorders. 

Answers to these questions are just beginning to evolve (Tables 5—5 through 5 — 10). For example, the incidence of depression is about 5% of the population, whereas the incidence of bipolar disorder is about 1%. Thus, up to 15 million individuals are currently suffering from depression and another 2 to 3 million from bipolar disorders in the United States. Unfortunately, only about one-third of individuals with depression are in treatment, not only because of underrecognition by health care providers but also because individuals often conceive of their depression as a type of moral deficiency, which is shameful and should be hidden. Individuals often feel as if they could get better if they just pulled themselves up by the bootstraps ... 

FIGURE 5—5- Bipolar disorder is characterized by various types of episodes of affective disorder, including depression, full mania, lesser degrees of mania called hypomania, and even mixed episodes in which mania and depression seem to coincide. 

Other mood stabilizers are arising from the group of drugs that were first developed as anticonvulsants and have also found an important place in the treatment of bipolar disorder. Several anticonvulsants are especially useful for the manic, mixed, and rapid cycling types of bipolar patients and perhaps for the depressive phase of this illness as well. Mood stabilizers will be discussed in detail in Chapter 7. An-tipsychotics, especially the newer atypical antipsychotics, are also useful in the treatment of bipolar disorders. 

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