Bipolar disorders case example

Because CBZ and valproate have been used for many years to treat seizure disorders in children and adolescents, more systematic knowledge about their clinical pharmacology in this age group is available than there is about lithium. However, pediatric patients with epilepsy are often on concomitant therapy with other anticonvulsants. That fact complicates attempts to extrapolate from this experience to the use of CBZ or valproate as monotherapy for childhood or adolescent bipolar disorder. For example, the risk of serious and potentially fatal hepatotoxicity with valproate occurs almost exclusively in children younger than age 10 years (usually 2 years or younger) who are on multiple anticonvulsants for congenital seizure disorders. How or whether this risk translates to children or adolescents who are on monotherapy with valproate for bipolar disorder is unknown. Nonetheless, clinicians need to be aware of this possible risk and take the following steps to increase the likelihood of early detection in case this problem arises ... 

Numerous reports of altered neurotransmitter and hormone functions which have been associated with the affective disorders are reviewed by Levell [142]. It was originally proposed that one or more of the neurotransmitter amines in the brain (norepinephrine, dopamine, serotonin) may be functionally elevated in manic patients and reduced in depressed patients [143]. For instance, an increase in the production of dopamine, observed in a number of case reports, is thought to be the cause of the switch into the manic phase in bipolar patients. For example, Bunney et al. reported an increase in the level of homovanillic acid (HVA), a... 

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. 

Paradoxically, ECT is equally useful in both the acute manic and depressive phases of bipolar disorder, constituting the only truly bimodal therapy presently available. For example, in their literature review, Mukherjee et al. ( 51) found that ECT was associated with marked clinical improvement or remission in 80% of patients undergoing treatment for an acute manic episode. This is not the case for lithium, valproate, or CBZ, which, at best, have relatively weak acute antidepressant effects. Drug therapies may also induce a switch from a depressed to a manic phase, whereas ECT can control both phases of the illness. 

It appears that a number of complications await the recovering bipolar patient after an episode of mania. For example, Lucas et al. ( 44) reported on a retrospective linear discriminant analysis of 100 manic episodes (1981 to 1985) during the recovery phase and found that the incidence of subsequent depression was 30% in the first month. Many episodes were transient, however, and did not necessarily require treatment. This phenomenon could be successfully predicted in 81% of cases in which there is a premorbid history of cyclothymia with either a personal or a family history of depression. The highly significant association between family history and postmanic depression again supports the hypothesis of a genetic basis for bipolar disorder. 

Occasionally, discoveries cannot be patented. For example, if you discover something novel, such as lithium ameliorating bipolar disorder, there is a problem. Lithium is a chemical element, not a new chemical compound that can be patented per se. Since the industry could not make much money making lithium tablets, there was less incentive to establish a use patent. Nowadays, for some cases such as this, there is an orphan drug statute in the United States, which, since 1983, gives a company a seven-year exclusivity and enables it to develop a drug treatment and still help patients. But this is a very slow and very difficult process. It is much better to patent, and let the patent drop should no one develop it into a coiranercial product, than not to patent at all. 

Manic attacks are usually a component of what is called bipolar, or manic-depressive, disorder periodic episodes of depression often arc experienced by these individuals as well. The following case (Spitzer et al., 1989) illustrates the manic component of bipolar disorder. It is an example of the development of manic symptoms late in life. 

Furthermore, a diet with low contents of FA may be involved in the development of insulin resistance, which suggests that an appropriate dietary intake of n-3 PUFA is considered protective against metabolic syndrome [183]. In addition, diverse psyquiatric impairs (depression, bipolar disorders, schizophrenia, autism) and neurodegenerative diseases such as Alzheimer disease have been associated to decreased blood levels of n-3 HUFA. Besides, there are many examples about the use of pol)nmsaturated FA as drugs. Thus, EPA has shown efficacy as adjunctive treatment, and in some cases as the only treatment in several psyquiatric disorders [184]. It is suggested that the potential of n-3 FA to prevent recurrence and metastasis of mammary cancer when used in adjuvant therapy is associated with a n-6 to n-3 ratio lower than 2 1 [185], On the other hand, fish intake is considered as a protective factor for preventing prostate cancer in addition, in humans low levels of ALA in mammary adipose tissue are associated with an increased risk of breast cancer in women [186]. 

In some cases, the pharmacology of the variants has not been fully characterized. For example, while the 524C>A, Leul33Ile CB2 variant has been associated with bipolar disorder, the pharmacological consequences of the variant are not fully unknown [306], By contrast, the CB2 variant, 315A>G, has been associated with major depression (MD) in Japanese population by [307]. 

Part II of the book outlines several mental-health diagnostic categories schizophrenia, mood disorders, depression, bipolar disorders, and specific anxiety disorders including generalized anxiety disorder and obsessive compulsive disorder. Each chapter provides a case example, consideration in diagnosis, and the interventions utilized. Medications used to treat these disorders and relevant psychosocial interventions are outlined. Each chapter emphasizes the need for accurate treatment planning and documentation and offers suggestions to facilitate this process. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

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