Bipolar I disorder

Depression often follows a manic episode (bipolar I disorder), but in other cases the main disorder presents as depressive episodes which are followed by or sometimes... 

Bowden CL, Calabrese JR, McElroy SL, et al (2000). A randomised, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Arch Gen Psychiatry 57, 481—9. 

Greil W, Kleindienst N (1999). The comparative prophylactic efficacy of lithium and carbamazepine in patients with bipolar I disorder. Int Clin Psychopharmacol 14,... 

Keck PE, Nabulsi AA, Taylor JL, et al (1996b). A pharmacoeconomic model of divalproex vs. lithium in the acute and prophylactic treatment of bipolar I disorder. J Clin Psychiatry 57> 213-22. 

Recognize the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for bipolar disorder as well as the subtypes of bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

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... 

Bipolar I disorder affects men and women equally bipolar II seems to be more common in women. Rapid cycling and mixed mania occur more often in women. Individuals with bipolar disorder commonly have another psychiatric disease with 78% to 85% reporting another Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis during their lifetime. The most common comorbid conditions include anxiety, substance abuse, and eating disorders.2... 

Bipolar disorder can be conceptualized as a continuum or spectrum of mood disorders and is not comprised solely of bipolar I disorder.9 They include four subtypes bipolar I (periods of major depressive, manic, and/or mixed episodes) bipolar II (periods of major depression and hypomania) cyclothymic disorder (periods of hypomanic episodes and depressive episodes that do not meet all criteria for diagnosis of a major depressive episode) and bipolar disorder, NOS. The defining feature of bipolar disorders is one or more manic or hypomanic episodes in addition to depressive episodes that are not caused by any medical condition, substance abuse, or other psychiatric disorder.1... 

TABLE 36-2. Algorithm and Guidelines for the Acute Treatment of Mood Episodes in Patients with Bipolar I Disorder... 

Lamotrigine is not approved for the acute treatment of depression, and the dose must be started low and slowly titrated up to decrease adverse effects if used for maintenance therapy of bipolar I disorder. A drug interaction and a severe dermatologic rash may occur when lamotrigine is combined with valproate (i.e., lamotrigine doses must be halved from standard dosing titration). 

Tegretol Chewable tablet 100 mg Target serum concentration for bipolar I disorder. 

Olanzapine Zyprexa 20, 30 mg Tablets 2.5, 5, 7.5, 10, 5-20 mg/day in 1 or 2 doses combination with lithium or valproate for the acute treatment of mania or mixed states for bipolar I disorder. Olanzapine and aripiprazole are approved for relapse prevention as well as for acute therapy... 

Introduced in clinical practice in the 1960s, lithium was the first mood stabilizer to be used in China. This was followed by carbamazepine and sodium valproate. For many years, these were the only treatment options available as mood stabilizers. Although lamotrigine was approved for maintenance treatment of bipolar I disorder in 2003 by FDA (Food and Drug Administration) in the USA, this indication has not yet been approved by the Chinese authorities. At present, only one atypical antipsychotic drug, risperidone, has been approved for treating acute mania (February 2005 by SFDA [State Food and Drug Administration]) in China (see Table 6.1). 

Zubieta, J. K., Huguelet, P., Ohl, L. E. etal. High vesicular monoamine transporter binding in asymptomatic bipolar I disorder sex differences and cognitive correlates. Am. J. Psychiatry 157 1619-1628, 2000. 

For bipolar I disorder, 90% of individuals who experience a manic episode later have multiple recurrent major depressive, manic, hypomanic, or mixed episodes alternating with a normal mood state. 

Suicide attempts occur in up to 50% of patients with bipolar disorder, and approximately 10% to 19% of individuals with bipolar I disorder commit suicide. Bipolar II patients may be more likely than bipolar I patients to attempt suicide. 

Suicidal ideation or attempts (suicide completion rates with bipolar I disorder are 10-15% suicide attempts are primarily associated with depressive episodes, mixed episodes with severe depression or presence of psychosis)... 

An example treatment algorithm for the acute treatment of mood episodes in patients with bipolar I disorder is shown in Table 69-6. 

Lamotrigine is approved for the maintenance treatment of bipolar I disorder. It has been used as monotherapy or add-on therapy for refractory bipolar depression. 

Aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone are FDA approved for the treatment of acute manic episodes in bipolar I disorder. 

Lamotrigine is effective for the maintenance treatment of bipolar I disorder in adults. It has both antidepressant and mood-stabilizing effects, and it may have augmenting properties when combined with lithium or valproate. It has low rates of switching patients to mania. Although it is less effective for acute mania compared to lithium and valproate, it may be beneficial for the maintenance therapy of treatment-resistant bipolar I and II disorders, rapidcycling, and mixed states. It is often used for bipolar II patients. 

Example 3 Is Bipolar I Disorder, Single Manic Episode (296.0x) a Taxon ... 

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... 

Severino, G., Congiu, D., Serreli, C., et al. (2005) A48G polymorphism in the receptor genes associated with bipolar I disorder. Am. J. Med. Genet. 134B, 37-38. 

Monotherapy For the treatment of acute mixed or manic episodes associated with bipolar I disorder and for the maintenance monotherapy of bipolar disorder. 

Combination therapy In combination with lithium or valproate for the short-term treatment of acute manic episodes associated with bipolar I disorder. 

Bipolar disorder For the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes (eg, depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy. 

Diagnostic criteria for 296.4 bipolar I disorder, most recent episode manic... 

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