Charles Bowden, MD, clinical professor in the department of psychiatry at the University of Texas Health Science Center, San Antonio, describes the management of patients with bipolar depression who are pregnant.
Charles Bowden, MD, clinical professor in the department of psychiatry at the University of Texas Health Science Center, San Antonio, describes the challenges physicians face when they treat patients with bipolar depression.
On the BSDS what score range indicates that there is a moderate probability of bipolar spectrum disorder? During euthymia, bipolar patients may have chronic impulsivity that predisposes them to aggression—especially those with comorbid features of which disorder? These questions and more in this quiz.
Do patients with the personality trait alexithymia have trouble understanding the written language? What percentage of patients with dementia have at least one psychiatric comorbidity? These and more in this quiz.
Have we created a mental health monster? The three factors largely responsible for the phenomenon described in this case are poor practice, managed care, and a pill-pushing society.Read More
Sometimes light is better conceptualized as a particle, sometimes as a wave. So in psychiatry: sometimes it is better to use a system of categories . . . Even if the particle-based view is less phenomenologically accurate for bipolar disorder we need not abandon the DSM system entirely. Read More
This scale is based on those questions that Dr Ronald Pies found most helpful in detecting not only severe cases of bipolar disorder but also patients who fall into the “softer” end of the bipolar spectrum.Read More
A meta-analysis recently published in the Journal of Clinical Psychiatry sheds new light on the safety and efficacy of antidepressants in the acute treatment of bipolar disorder. The article is noteworthy because, as Dr Ronald Pies, comments: antidepressants are the most common drug treatment in bipolar disorder, but probably the least well validated.
Is combination therapy with lithium and valproate more effective in preventing relapses in patients with bipolar I disorder than montherapy with either drug alone?The authors of a study that recently appeared in The Lancet set out to address that important question. Dr. S. Nassir Ghaemi has chosen that study as his “Top Paper” of the year. Dr Ghaemi, who is professor of psychiatry at Tufts University School of Medicine and Director of the Mood Disorders Program at Tufts Medical Center, discusses highlights -- and the clinical implications.
Evid Based Mental Health. 2012; 15: 45 doi: 10.1136/ebmental-2011-100476. Therapeutics. Review: risperidone, olanzapine and haloperidol are the most effective drugs for acute mania in adults with bipolar ... Participants had to be above the age of 18
Mental health disorders ( defined using DSM-IV criteria): any mood disorder ( major depression, dysthymia, bipolar I, bipolar II), any anxiety disorder ( panic disorder, social phobia, specific phobia, post-traumatic stress disorder,
Evid Based Mental Health. 2012; 15: 12 doi: 10.1136/ebmental-2011-100319. Prevalence. Review: some evidence of impaired neurocognitive performance in children and adolescents with bipolar disorder. ... Do children and adolescents with bipolar disorder
Evid Based Mental Health. 2012; 15: 14 doi: 10.1136/ebmental-2011-100348. Prognosis. Mortality gap between people with schizophrenia or bipolar disorder and the general population persists in England. ... Has the risk of mortality in people with
Evid Based Mental Health. 2012; 15: 19 doi: 10.1136/ebmental-2011-100281. Therapeutics. Review: second-generation antipsychotics improve response in paediatric bipolar disorder, but are associated with adverse events. ... Additionally, the references of
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Little longitudinal research has examined progression to more severe bipolar disorders in individuals with "soft" bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a nonpatient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of "soft" bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial
Monitoring mental health treatment outcomes for populations requires an understanding as to which patient information is needed in electronic format and is feasible to obtain in routine care.|To examine whether bipolar disorder outcomes can be accurately predicted and how much clinical detail is needed to do so. RESEARCH DESIGN, DATA SOURCES, AND PARTICIPANTS: Longitudinal study of bipolar disorder patients treated during 2000 to 2004 in the 19-site Systematic Treatment Enhancement Program for Bipolar Disorder observational study arm (N=3168). Clinical data were obtained at baseline and quarterly for over 1 year. We fit a "gold standard" longitudinal random-effects regression model using a detailed clinical information and estimated the area under the receiver operating characteristic curve (AUC) to predict accuracy using a validation sample. The model was then modified to include patient characteristics feasible in routinely collected electronic data (eg, administrative data). We
It has been held that if bipolar disorder is categorically distinct, it should differentiate from unipolar depressive disorders by showing bimodality or a 'zone of rarity' in bipolar symptom scores. Two previous studies have failed to demonstrate bimodality. We undertook a third study.|A total of 1106 patients attending the Black Dog Institute Depression Clinic completed the Mood Disorders Questionnaire (MDQ), in addition to undergoing clinical assessment by an Institute psychiatrist.|The distributions of scores for the total number of hypomanic symptoms endorsed by unipolar and bipolar patients were both skewed, with the bipolar group endorsing a high number of hypomanic symptoms and the unipolar group endorsing few symptoms--and so giving the impression of an 'even' distribution generated by two quite distinctly differing sub-groups. However, formal statistical analyses involving mixed modelling provided no clear evidence that a bimodal distribution provided a better fit to the data
Physician Performance Goals Are Great, But Balance Is More Realistic Jennifer Frank, MD, May 15, 2012 Performance measurements for physicians are well-intentioned and get me to rethink how I practice. But in the end I won't make the goals, so I'll have to go with balance over perfection.
Designing the Perfect Business Card for Your Medical Practice C. Noel Henley, MD, May 11, 2012 Does your business card say anything substantive about the valuable work you do in your practice? Here’s how to re-design your next business card for maximum impact and engagement.
Registered Nurses an Ideal Fit for Primary Care Practices Audrey "Christie" McLaughlin, RN, May 10, 2012 Here are four good reasons to hire a registered nurse for your primary care practice …maybe even instead of a medical assistant.
The Five Biggest Medical Practice Marketing Mistakes James Doulgeris, May 10, 2012 There are best practices to marketing your practice, but often, success is more about knowing what not to do. Here are the five most common pitfalls …and how to avoid them.
Can You Practice Medicine and Manage Your Practice? Rosemarie Nelson, May 9, 2012 Whether you practice alone, or in a group, if you're trying to see patients in this pay-for-volume environment and also run the business of your practice, you may be missing out on important opportunities.