Psychiatric disorders bipolar disorder

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

Centorrino F, Albert MJ, Berry JM, Kelleher JP, Fellman V, Line G, Koukopoulos AE, Kidwell JE, Fogarty KV, Baldessarini RJ. Oxcarbazepine clinical experience with hospitalized psychiatric patients. Bipolar Disord. 2003 5 370-4. 

Although lithium is not a true antipsychotic drug, it is considered with the antipsychotics because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder (a psychiatric disorder characterized by severe mood swings of extreme hyperactivity to depression). During the manic phase, the person experiences altered thought processes, which can lead to bizarre delusions. The drug diminishes the frequency and intensity of hyperactive (manic) episodes. 

American Psychiatric Associarion (1994). Practice guideline for the treatment of patients with bipolar disorder. Am JPsychiatry 151 (suppl. 12), 1-36. 

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... 

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 ... 

Interpersonal, family, or group therapy with a licensed psychiatric nurse practitioner/clinical nurse specialist, psychologist, social worker, or counselor assists individuals with bipolar disorder to establish and maintain a daily routine and sleep schedule and to improve interpersonal relationships.3,20 These therapies may help treat and protect against manic episodes. 

Treatment of elderly patients with bipolar disorder requires special care because of increased risks associated with concurrent non-psychiatric medical conditions and drug-drug interactions. General medical conditions including endocrine,... 

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

Pearlson, G. D., Wong, D. F., Tune, L. E. et al. In vivo D2 dopamine receptor density in psychotic and nonpsychotic patients with bipolar disorder. Arch. Gen. Psychiatr. 52 471-177, 1995. 

Bipolar disorder, previously known as manic-depressive illness, is a cyclical, lifelong disorder with recurrent extreme fluctuations in mood, energy, and behavior. Diagnosis requires the occurrence, during the course of the illness, of a manic, hypomanic, or mixed episode (not caused by any other medical condition, substance, or psychiatric disorder). 

Data from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision. Washington, DC American Psychiatric Association, 2000 382-401 Goldberg JF, Harrow M, eds. Bipolar Disorders Clinical Course and Outcome. Washington, DC American Psychiatric Press, 1999 and Goodnick PJ, ed. Mania Clinical and Research Perspectives. Washington, DC American Psychiatric Press, 1998. 

There are, however, subgroups of young adults who may not mature out of drug problems as easily as others. Those who seem to have problems maturing out usually have other problems that preceded the onset of drug use. For instance, researchers have found that young adults who have a history of Conduct Disorder or who have other psychiatric disorders (such as schizophrenia, Bipolar Disorder, depression, Anxiety Disorder, or a major personality disorder) mature out of drug problems at much lower rates than those who do not have these additional problems. 

Another way that professionals assess for psychiatric disorders is to use an inventory that assesses for personality characteristics. The most famous of these inventories is the Minnesota Multiphasic Personality Inventory (MMPI), which is now in its second edition as an instrument. Although the MMPI is actually a personality inventory, as it names suggests, many professionals will use it to spot suspected psychiatric disorders, such as depression, Bipolar Disorder, Schizophrenia, and Anxiety Disorder. The MMPI has several scales to assess common personality traits, such as depression, mania, psychopathic deviance, and even alcohol and drug use (Weed, Butcher, McKenna, Ben-Porath, 1992). 

Chronic use has been associated with an "amotivational syndrome" characterized by loss of interest in social activities, school, work, or other goal-directed activities. Cannabis use is cited as the cause of this phenomenon, but there is no evidence to support any causal relationship. There is evidence, however, that the symptoms of the "amotivational syndrome" are secondary to depression (Musty and Kraback 1995). In contrast to ethanol, there is no evidence to support that cannabis causes an increase in violent behavior (Murray 1986). However, cannabis use may be contraindicated in those with preexisting psychiatric disturbances such as bipolar disorder or schizophrenia. 

The mood disorders were once called affective disorders and are grouped into two main categories unipolar and bipolar. The unipolar depressive disorders include major depressive disorder and dysthymic disorder the bipolar disorders include bipolar 1, bipolar II, bipolar not otherwise specified, and cyclothymic disorder. Other mood disorders are substance-induced mood disorders and mood disorders due to a general medical condition. In addition, mood disturbance commonly occurs as a symptom in other psychiatric disorders including dementia, post-traumatic stress disorder, substance abuse disorders, and schizophrenia. 

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

Goodwin FK, Goldstein MA. Optimizing lithium treatment in bipolar disorder a review of the literature and clinical recommendations. J Psychiatr Pract 2003 9(5) 333-343. 

Believed historically to be a relatively rare disorder, large-scale epidemiological research undertaken during the last 20 years indicates that OCD is in fact quite common. The lifetime prevalence of OCD is 2-3%, making it more common, in fact, than bipolar disorder, schizophrenia, and most psychiatric illnesses other than depression and the substance use disorders. 

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. 

Mood Stabilizers. Lithium (Eskalith, Lithobid), valproic acid (Depakene), sodium valproate (Depakote), and carbamazepine (Tegretol) are most often used by psychiatrists to treat the bipolar disorders. These so-called mood stabilizers are also used to treat impulsivity and agitation in a variety of psychiatric disorders including dementia, certain personality disorders, and the disruptive behavior disorders of childhood. 

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