Bipolar disorders screening

Screening patients for bipolar disorder Prior to initiating treatment with an antidepressant, adequately screen patients with depressive symptoms to determine if they are at risk for bipolar disorder. 

Screening patients for bipolar disorder A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Prior to initiating treatment with an antidepressant, adequately screen patients with depressive symptoms to determine if they are at risk for bipolar disorder. 

Glueck et al. assessed hypocholesterolemia in 203 patients hospitalized with affective disorders (depression, bipolar disorder, and schizoaffective disorder), 1595 self-referred subjects in an urban supermarket screening, and 11,864 subjects in the National Health and Nutrition Examination Survey II (a national probability sample) [34], Low plasma cholesterol concentration (<160 mg/dL) was much more common in patients with affective disorders than in those found in urban supermarket screening subjects or in the National Health and Nutrition Examination Survey II subjects. When paired with supermarket screening subjects by age and sex, patients with affective disorders had much lower TC, LDL, HDL, and higher TG concentrations. However, there was no evidence that low plasma cholesterol could cause or worsen affective disorders [34]. 

When 22 women with bipolar disorder (10 taking lithium alone, 10 taking divalproex alone, and 2 taking both) were evaluated for polycystic ovary syndrome, none had typical hormonal screening abnormalities (427). Some type of menstrual dysfunction was present in all ten women taking lithium alone, but it predated use of the drug in all but one. 

This design may help to screen out placebo responders as well as bipolar depressed patients with transient exacerbations of symptoms, or subjects suffering from anxiety disorders in response to environmental psychological stressors. However, the value of this design is limited because it will not reduce potential investigator bias, i.e. the expectation of pharmacological effects after a given time. 

Erdmann J, Nothen MM, Shimron-Abarbanell D, et al. The human serotonin 7 (5-HT7) receptor gene genomic organization and systematic mutation screening in schizophrenia and bipolar affective disorder. Mol Psychiatry 1996 1 392-397. 

Fallin MD, Lasseter VK, Avramopoulos D, Nicodemus KK, Wolyniec PS, et al. 2005. Bipolar I disorder and schizophrenia A 440-single-nucleotide polymorphism screen of 64 candidate genes among Ashkenazi Jewish case-parent trios. Am J Hum Genet 77 918-936. 

The major psychological adverse effects of cannabis include anxiety, paranoia, and psychosis. Thus, psychological screening should include a detailed psychiatric evaluation to identify individuals with a history of anxiety, paranoia, psychosis, or psychiatric disorders such as depression, manic depression (bipolar), panic disorder, or schizophrenia, which may be exacerbated by cannabis. 

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