Bipolar disorders definitions

Lifetime prevalence rates of psychiatric comorbidity co-existing with bipolar disorder are 42% to 50%.16 Comorbidities, especially substance abuse, make it difficult to establish a definitive diagnosis and complicate treatment. Comorbidities also place the patient at risk for a poorer outcome, high rates of suicidal-ity, and onset of depression.2 Psychiatric comorbidities include ... 

Although this is an area in which research is burgeoning, definite evidence of the effectiveness of EFAs in the treatment of mental disorders is lacking. There are some controlled trials of varying methodological quality in adult patients with schizophrenia, and unipolar and bipolar depression, with conflicting results (Fenton et ah, 2000 Maidment, 2000). The most encouraging trial is a preliminary study of 30 patients with bipolar disorder. It found that EFAs concurrent with mood stabilizers reduced the rate of recurrence of episodes (Stoll et al., 1999). 

Controlled studies involving lipid manipulation in children date back to the 1920s, when the ketogenic diet was pioneered to control treatment-resistant seizures in select pediatric populations (Freeman et al., 1998). However, no controlled evidence is available in children with depression, bipolar disorder, behavioral problems, or ADHD. In the absence of definite empirical data about effectiveness, treatment with EFA supplements should be considered unproven and patients ought to be advised accordingly. 

Valproate, a simple branched-chain fatty acid, was first reported as a successful treatment for acute mania by Lambert and colleagues in 1966. Following this report, at least 16 uncontrolled trials consistently supported the observation that valproate has acute and long-term mood-stabilizing effects in patients with bipolar disorder (reviewed by Keck et al. 1992a). Recently, five double-blind controlled studies of valproate have been completed that provide definitive evidence of its efficacy in acute mania. 

The most serious theoretical side effect of inositol treatment could be reversal of therapeutic effects of Li or induction of mania in patients with bipolar disorder. So far, this has not been definitely seen in four patients with bipolar depression who were treated with full 12 g of inositol daily for depression [Levine et al. 1995a] or in 18 Li -treated patients with bipolar disorder who were treated with low-dose inositol for polyuria [Bersudsky et al. 1992] or EEG abnormalities [Barak et al. 1994]. The pathophysiological relationship of inositol reversal of Li side effects and inositol therapeutic efficacy in depression and panic is not clear. 

Lithium, several (but not all) anticonvulsants, and most of the atypical antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for the treatment of one of more phases of bipolar disorder. These medications are referred to as mood stabilizers, and they are the foundation of treatment for bipolar disorders. However, the skillful treatment of bipolar disorder requires not only the knowledge of how to prescribe one or more of these medications but also the understanding that some medications are preferred for one phase of the illness but not the other or for long-term use but not necessarily acute use. In this chapter, we first review the clinical use of lithium and the anticonvulsants that are definite or probable mood stabilizers. The general properties of atypical anti-psychotics are reviewed in Chapter 4. In this chapter, we expand on the use of these compounds for the treatment of bipolar disorder. Discussion of the treatment of each phase of bipolar disorder concludes the chapter. 

In another serendipitous finding, Cade noted that the first patient treated with lithium relapsed when medication was withdrawn ( 5). From this, he inferred that lithium may also be effective for maintenance treatment. Baastrup, Schou s coworker, carried out the first definitive study of its prophylactic properties ( 4, 6, 7 and 8). The ability of lithium to decrease the rate of recurrence in both unipolar and bipolar disorders was then confirmed in a series of studies by Hartigan and Baastrup ( 7, 8 and 9). 

Because lithium has long been the standard treatment for bipolar disorder, it is often the drug of first choice. Increasingly, however, VPA has emerged as a viable alternate first-line therapy. CBZ, marketed as an anticonvulsant, has also been studied and used for its mood-stabilizing properties. There has never been a definitive controlled study, however, comparing the efficacy of lithium with other mood stabilizers in difficult-to-treat manic patients. 

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. 

Angst, J., Gamma, A., Benazzi, R, Ajdacic, V., Eich, D., Rossler, W. 2003, Toward a re-definition of subthreshold bipolarity epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania, . Affect.Disord., vol. 73, no. 1-2, pp. 133-146. 

J. Rosenthal et al. s (1986) dysregulation theory includes (but by definition is not specific to) bipolar disorder. In this model, mood is regulated by several homeostatic mechanisms. The failure of a component part leads to the expression of mood outside of set limits, which are identified as the "symptoms" of mania and depression. R. Post, S. Weiss, and O. Chuang (1992) offer a similar explanahon that overactivity in either of the mediating "circuits" of mania or depression leads to the appearance of associated behavioral manifestations. 

Comparative studies Risperidone and divalproex In a retrospective study of 28 patients aged 5-14 years with bipolar disorder who had been treated with risperidone (n = 16) or divalproex (n = 12), risperidone was associated with faster clinical improvement and significantly more weight gain than divalproex (mean changes 2.46 kg versus 0.43 kg) however, the small sample size precluded definitive conclusions [120 . ... 

Bipolar I Disorder, Single Episode (296.0x) is one of many DSM-1V diagnoses for which the taxonic status cannot be directly tested (American Psychiatric Association, 1994). The problem lies with the structure of the 296.0x diagnosis. Unlike the definition of panic disorder, 296.0x lacks a unique... 

Schizophrenia-related disorders, such as schizophreniform disorder, can closely mimic an acute exacerbation of mania. Attention to premorbid personal and family history may help differentiate them from mood disorders. A definitive diagnosis may not be possible, however, until the course of the illness is followed for a period of time. Clinical clues include the propensity of bipolar manics (in contrast to schizophrenics) to demonstrate pressured speech, flight of ideas, grandiosity, and overinclusive thinking. Hallucinations are less common than delusions in both mania and depression, with delusions normally taking on the qualities of expansivity, hyperreligiosity, or grandiosity. Delusions are also relatively less fixed than in schizophrenia. 

Approximately 1% to 3% of the adult population has either bipolar I or II disorder, but broader definitions suggest prevalence rates up to 5% if the full spectrum of recurrent mood disorders are included. A national comorbidity survey reported that the lifetime prevalence rate of a manic episode is 1.6% 0.3% for men and 1.7% 0.3% for women in the United States (approximately 4 million people). The... 

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