Manic-depressive syndrome

Manic-depressive syndrome antidepressants, lithium prophylactically... 

It is becoming clear that certain of the trace elements are very important in determining human behavior. For example, lithium (administered as lithium carbonate) has been a miracle drug for some people afflicted with manic-depressive syndrome, a disease that produces oscillatory behavior between inappropriate highs and the blackest of depressions. Although its exact function remains unknown, lithium seems to moderate the levels of neurotransmitters (compounds that are essential to nerve function), thus relieving some of the extreme emotions in sufferers of manic-depressive disease. 

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Caine ED, Polinsky RJ Haloperidol induced dysphoria in patients with Tourette syndrome. Am J Psychiatry 236 1216-1217, 1979 Caine ED, Weingartner H, Ludlow EA, et al Qualitative analysis of scopolamine-induced amnesia. Psychopharmacology 74 74-80, 1981 Calabrese JR, Delucchi GA Spectrum of efficacy of valproate in 55 rapid-cycling manic depressives. Am J Psychiatry 147 431-434, 1990 Calabrese JR, Markowitz PJ, Kimmel SE, et al Spectrum of efficacy of valproate in 78 rapid-cycling bipolar patients. J Clin Psychopharmacol 12 (suppl 53-56, 1992... 

Mufson EJ, Cochran E, Benzing W, et al Galaninergic innervation of the cholinergic vertical limb of the diagonal band (Ch2) and bed nucleus of the stria terminahs in aging, Alzheimer s disease and Down s syndrome. Dementia 4 237-250, 1993 Muhlbauer HD The influence of fenfluramine stimulation on prolactin plasma levels in lithium long-term-treated manic-depressive patients and healthy subjects. Pharmacopsychiatry 17 191-193, 1984... 

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)(8), mixed episodes occur when full manic and full depressive syndromes occur together. 

Affective disorders comprise the group of mental conditions that includes depression, bipolar syndrome (manic-depression), and several others that are characterized by a marked disturbance in a patient s mood.41 Patients with an affective disorder typically present with an inappropriate disposition, feeling unreasonably sad and discouraged (major depressive disorder) or fluctuating between periods of depression and excessive excitation and elation (bipolar disorder). 

The form of depression discussed previously is often referred to as major depressive disorder or unipolar depression, in contrast to bipolar or manic-depressive disorder. As these terms imply, bipolar syndrome is... 

Butyrophenones are used to treat psychoses including schizophrenia, organic psychosis, paranoid syndrome, acute idiopathic psychotic illnesses, and the manic phase of manic depressive illness. Other uses... 

Verapamil has also been used in the treatment of mania, depression, maintenance control of manic depression, and schizophrenia. In addition, it has been used in the management of premenstrual syndrome, stuttering, and intoxication with phencyclidine. 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Goltermann NR, Rehfeld JF, Roigaard-Petersen H In vivo biosynthesis of cholecystokinin in rat cerebral cortex. J Biol Chem 255 6181-6185, 1980 Goncalves N, Stoll KD Carbamazepine in manic syndromes a controlled double-blind study. Nervenarzt 56 43-47, 1985 Gonella G, Baignoh G, Ecari U Fluvoxamine and imipramine in the treatment of depressive patients a double-blind placebo-controlled study. Curr Med Res Opin 12 177-184, 1990... 

Grunhaus L Clinical and psychobiological characteristics of simultaneous panic disorder and major depression. Am J Psychiatry 145 1214-1221, 1988 Grunze H, Walden J, Wolf R, et al Combined treatment with lithium and nimodipine in a bipolar 1 manic syndrome. Prog Neuropsychopharmacol Biol Psychiatry 20 419-426, 1996... 

Given that the seat of hormonal modulation is in the limbic-hypothalamic-pituitary axis, endocrine changes serve as important correlates to major psychiatric disorders. These changes include basal hormone concentrations, as well as responses to pharmacological challenges. Equally important, endocrine disorders may present with psychiatric symptoms (e.g., manic symptoms in hyperthyroidism, severe depression in hypercortisol ism, psychotic symptoms associated with Cushing s syndrome). Commonly used neuroendocrine tests include the following. 

Mixed manic states can be characterized as the simultaneous presence of both a depressive and manic episode, meeting full criteria for both mood syndromes (except for duration) nearly every day for at least one week. This may be a relatively common occurrence, as noted earlier in the data of Goodwin and Jamison (i.e., 71% present with euphoria and 72% with depression), as well as others (30a) (9). Krasuski and Janicak (31, 32) reviewed various models to explain the interaction between mania or hypomania and depression and noted that aggression and anxiety may be important components, in addition to dysphoria, in defining mixed states. 

The most serious side effects of efavirenz are psychiatric symptoms, rash and nervous symptoms. The psychiatric symptoms include suicide thoughts, depression, paranoia, manic disorders and aggressive behavior the rashes include macu-lopapular skin eruptions and life-threatening Stevens-Johnson syndrome has also been reported. The neurological symptoms are difficulty in concentration, insomnia, dizziness, confusion, agitation, hallucinations and amnesia. Additional side effect may include an increase in cholesterol and hepatic transaminase levels. 

Antipsychotic drugs commonly have been used empirically to manage manic and psychotic illness in bipolar disorder patients. Indeed, standard neuroleptics are a mainstay of the treatment of acute mania (only chlorpromazine is FDA-approved for this indication, although haloperidol has also been widely used) and for manic episodes that break through prophylactic treatment with LF or an anticonvulsant. However, the older antipsychotics are not used routinely for long-term prophylactic treatment in bipolar disorder because their effectiveness is untested, some may worsen depression, and the risk of tardive dyskinesia in these syndromes may be higher than in schizophrenia. 

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