Depression bipolar affective disorder

Affective (mood) disorders are characterized by changes in mood. The most common manifestation is depression, arranging from mild to severe forms. Psychotic depression is accompanied by hallucinations and illusions. Mania is less common than depression. In bipolar affective disorder, depression alternates with mania. 

Bipolar Affective Disorder. A class of disorders that features mood swings from great highs (mania) to great lows (depression). 

In the bipolar affective disorders (BPADs), periods of normal mood are interspersed with episodes of mania, hypomania, mixed states, or depression. BPAD differs from MDD in that there is a bidirectional natnre to the mood swings and, for many patients, the rate of cycling is more rapid in BPAD than MDD. The phases of BPAD inclnde mania, hypomania, and depression, though mixed states, the simultaneous presentation of symptoms of both mania and depression, are common. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

Disorders that are characterised by changes in mood are known as affective disorders, which are depression and mania, now known as unipolar and bipolar affective disorders, respectively. Mood is considered to depend upon the concentration of an amine neurotransmitter in some parts of the brain. 

Indications include a wide variety of psychiatric disorders, in the first place schizophrenia, organic psychoses and other acute psychotic illnesses. However they are also of use for the manic phase of bipolar affective disorder and for psychotic depression. Under antipsychotic drug therapy patients become less agitated and restless, withdrawn and autistic patients may become more communicative, aggressive and impulsive behavior diminishes and hallucinations and disordered thinking disappear. 

In a 1994 study Teplin evaluated 728 male jail detainees, and found that nearly two-thirds of this population had a psychiatric disorder with antisocial personality disorder (ASP), the most common diagnosis at 50%. However, 35% of the population had a current diagnosis other than ASP, and two-thirds had previously been given a lifetime diagnosis other than ASP. Substance abuse was common, with a 62% lifetime prevalence. More than one out of three detainees had a severe mental disorder (schizophrenia, bipolar affective disorder, or major depression). In another study, 693 homicide offenders were evaluated and elevated rates of schizophrenia and ASP were found (Eronen et al., 1996). Earlier studies found schizophrenia in 29%-75% and affective disorders in 4%-35% of prisoners. 

Berk M, Kirchmann NH, Butkow N Dthium blocks 45Ca uptake into platelets in bipolar affective disorder and controls. Clin Neuropharmacol 19 48-51, 1996 Berman RM, Darnel AM, Anand A, et al Effect of pindolol in hastening response to fluoxetine in the treatment of major depression a double-blind placebo-controlled trial. Am J Psychiatry 154 37-43, 1997 Bernard M, Vergoni AV, Sandiini M, et al Influence of ovariectomy, estradiol and progesterone on the behavior of mice in an experimental model of depression. Physiol Behav 45 1067-1068, 1989... 

D haenen HA, Bossuyt A Dopamine D2 receptors in depression measured with single photon emission computed tomography. Biol Psychiatry 35 128-132, 1994 Di Costanzo E, Schifano E Dthium alone or in combination with carbamazepine for the treatment of rapid-cycling bipolar affective disorder. Acta Psychiatr Scand 83 456-459, 1991... 

Lithium salts are used in the treatment of bipolar affective disorder (i.e., manic depression) and occasionally in mania (but its slow onset of action is somewhat of a disadvantage in this case). Its mechanism of action is still open to debate, but lithium has effects on brain monoamines, on neuronal transmembrane sodium flux, and on cellular phosphatidylinositides related to second messenger systems. Lithium is administered in two salt forms, lithium carbonate (8.98) and lithium citrate (8.99). Side effects are common and include diarrhea, kidney failure, and drowsiness with tremor. 

Rieder RO, Mann LS, Weinberger DR, et al. Computed tomographic scans in patients with schizophrenia, schizoaffective, and bipolar affective disorder. Arch Gen Psychiatry 1983 40 735-739. Tsuang MT, Winokur G, Crowe RR. Morbidity risks of schizophrenia and affective disorders among first degree relatives of patients with schizophrenia, mania, depression, and surgical conditions. Br J Psychiatry 1980 137 497-504. 

For patients with bipolar affective disorder (manic-depressive illness) lithium, usually in the form of lithium carbonate, has been the main prophylactic agent for the last forty years. However, during the last ten years certain anticonvulsants (carbamazepine and sodium valproate) have also been found to be effective. 

The sequence, number, and intensity of manic and depressive episodes are highly variable. The cause of the mood swings characteristic of bipolar affective disorder is unknown, although a preponderance of catecholamine-related activity may be present. Drugs that increase this activity tend to exacerbate mania, whereas those that reduce activity of dopamine or norepinephrine relieve mania. Acetylcholine or glutamate may also be involved. The nature of the abrupt switch from mania to depression experienced by some patients is uncertain. Bipolar disorder has a strong familial component, and there is abundant evidence that bipolar disorder is genetically determined. 

Lithium Mechanism of action uncertain suppresses inositol signaling and inhibits glycogen synthase kinase-3 (GSK-3), a multifunctional protein kinase No significant antagonistic actions on autonomic nervous system receptors or specific CNS receptors no sedative effects Bipolar affective disorder-prophylactic use can prevent mood swings between mania and depression Oral absorption, renal elimination half-life 20 h. narrow therapeutic window (monitor blood levels) Toxicity Tremor, edema, hypothyroidism, renal dysfunction, dysrhythmias pregnancy category D Interactions Clearance decreased by thiazides and some NSAIDs... 

Q1 The swings of mood from depression Lo mania suggest a diagnosis of manic depressive disorder (bipolar affective disorder). In this condition, the cycle of manic and depressive periods can take place over months or years, but may occur rapidly over weeks or days this varies between patients. On the other hand, there may be several episodes of depression which follow each other, or the patient may experience several episodes of mania in succession. 

Manic depressive disorder (bipolar affective disorder) is characterized by swings of mood from depression to mania. A patient may be at an increased risk of developing the condition if a first-degree relative is similarly affected. 

In a review of five randomized controlled trials of prevention of relapse in 770 patients with bipolar affective disorder, lithium has been compared with placebo (98). Lithium was more effective than placebo in preventing all relapses and manic relapses, but the effect on depressive relapses was not as impressive and was termed equivocal by the authors. This is not particularly new information, although several of the studies that were included in this meta-analysis were more recent and the analysis was presented as odds ratios rather than episode frequency. 

Dr. J. F. J. Cade, an Australian psychiatrist, first reported on the beneficial use of a lithium compound for a psychiatric disorder, namely, manic behavior in 1949. The early human trials were undertaken after initial experiments on rats, which became quite lethargic after treatment with lithium urate. Fairly large doses were required for treating manic behavior and its use for this disorder has been displaced by organic drugs that carry less risk. His report, however, led to its current nse as a treatment for bipolar affective disorder (also known as manic-depressive disorder). Its use in the United States was curtailed for a decade and a half by the US. Food and Dmg Administration (FDA), which based its decision on incidental poisonings due to overuse of a lithium-based table salt substitute, despite a safe record of controlled psychiatric apphcations in Europe. It has been estimated that by 1985... 

Manic depression currently affects up to 2 percent of the world s population. Clinical studies demonstrate proven effectiveness of lithimn treatment for bipolar affective disorder. Lithium is taken orally and has been used successftdly by some patients for periods exceeding a decade. The action is prophylactic, meaning that it is able to prevent the occurrence of the manic and depressive mood swing phases of the disease once the patient has been... 

In bipolar affective disorder patients suffer episodes of mania, hypomania and depression, classically with periods of normal mood in between. Manic episodes involve greatly elevated mood, often interspersed with periods of irritability or undue... 

Carbamazepine is licenced as an alternative to lithium for prophylaxis of bipolar affective disorder, although clinical trial evidence is actually stronger to support its use in the treatment of acute mania. Carbamazepine appears to be more effective than lithium for rapidly cycling bipolar disorders, i.e. with recurrent swift transitions from mania to depression. It is also effective in combination with lithium. Its mode of action is thought to involve agonism of inhibitory GABA transmission at the GABA-benzodiazepine receptor complex (see also Epilepsy, p. 417). 

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