Although antidepressants are advised only as second-line treatment in patients with bipolar disorder, the matter is complicated by conflicting data surrounding antidepressant use during pregnancy. Read More
The diagnosis of bipolar disorder is typically associated with significant disability and impaired functioning. This article explores the pros and cons of functional and quality-of-life measures. Read More
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.
To the Editor: Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimers disease. Patients with PD develop motor symptoms such as muscular rigidity, slowness of movement, and reduced gait speed, as well as non-motor deficits such as disorders of mood and distinctive alteration of speech and voice (hypokinetic dysarthria).1 The severity of PD can be
To the Editors: Miss H, a 17-year-old girl, did not have history of mooddisorders, conduct problems, substance misuse, or physical illness. She was diagnosed with schizophrenia at age 16, with initial presentations of persecutory delusion and formal thought disorder. She received comprehensive physical examinations, and organic etiology was excluded. Because of aggravated psychotic symptoms, she was admitted for 1 week. He
To the Editor: Vitamin-B12 deficiency (VB12D) has been associated with neuropsychiatric abnormalities like posterolateral myelopathy, peripheral neuropathy, autonomic neuropathy, optic atrophy, mooddisorders, psychosis, delirium, and dementia (especially in elderly persons).1 However, a strong causal relationship between VB12D and dementia has not been established.
The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies
AbstractObjective To evaluate the effectiveness of a behavioural-educational sleep intervention delivered in the early postpartum in improving maternal and infant sleep.Design Randomised controlled trial.Setting Postpartum units of two university affiliated hospitals.Participants 246 primiparous women and their infants randomised while in hospital with an internet based randomisation service to intervention (n=123) or usual care (n=123) groups.Interventions The behavioural-educational sleep intervention i
Self-rated screening studies suggest higher prevalence rates for bipolar disorder than previously thought, but the validity of self-administered diagnostic tools has not been well established in mood-disordered patients with substance misuse.|We conducted a cross-sectional assessment of 113 English-speaking, nonintoxicated adults aged 18-69 years who were seeking treatment for mood or anxiety symptoms and substance use symptoms. (Subjects with anxiety complaints at initial presentation were included to possibly increase the pool of subjects with mood symptoms upon formal evaluation.) Subjects were consecutively evaluated from January 2010 through May 2011 at the time of voluntary admission to a private, not-for-profit psychiatric hospital. All subjects completed the Mood Disorder Questionnaire (MDQ), followed by a psychiatrist's review of their responses, using the MDQ as a semistructured interview. MDQ item and total agreements were compared for patient self-report versus clinician
Antiepileptic drugs (AEDs) are used to treat various nonepileptic central nervous system (CNS) disorders, both in neurology and psychiatry. Most AEDs have multiple mechanisms of action (MOAs), which include modulation of -aminobutyric acid (GABA)ergic and glutamatergic neurotransmission, and alteration of voltage-gated ion channels or intracellular signaling pathways. These MOAs may explain the efficacy of AEDs in the treatment of bipolar disorder and neuropathic pain. Bipolar disorder and epilepsy have some common features, such as their episodic nature and associated kindling phenomena, which led to the regulatory approval and use of the AEDs carbamazepine (CBZ), valproic acid (VPA), and lamotrigine (LTG) in the treatment of bipolar disorder. A major limitation for the development of drugs with improved mood-stabilizing activity is the lack of knowledge on the mechanism of treatment for bipolar disorder. In contrast to epilepsy, no animal models in bipolar disorder are universally
Little is known about the risks of mood and anxiety disorders among Asians with alcohol use disorders and the effect of illicit drug use in this population. All participants from the 2008 Thai National Mental Health survey (N=17,140) were assessed for current major depressive disorder, anxiety disorders, and alcohol use disorders by using the Mini International Neuropsychiatric Interview (MINI) and were interviewed for illicit drug use within one year prior to their assessment. Logistic regression modeling was used to determine (a) whether alcohol use disorders were associated with major depressive disorder and anxiety disorders and (b) whether the use of illicit drugs increased these associations. Sex, age, marital status, region, and educational level were found to be significantly associated with major depressive disorder and anxiety disorders and were taken into account in the regression analysis. Compared with the general population, individuals with alcohol use disorders alone
Patients with bipolar disorder are known to be at high risk of premature death. Comorbid cardio-vascular diseases are a leading cause of excess mortality, well above the risk associated with suicide. In this review, we explore comorbid medical disorders, highlighting evidence that bipolar disorder can be effectively conceptualized as a multi-systemic inflammatory disease.|We conducted a systematic PubMed search of all English-language articles recently published with bipolar disorder cross-referenced with the following terms: mortality and morbidity, cardio-vascular, diabetes, obesity, metabolic syndrome, inflammation, auto-antibody, retro-virus, stress, sleep and circadian rhythm.|Evidence gathered so far suggests that the multi-system involvement is present from the early stages, and therefore requires proactive screening and diagnostic procedures, as well as comprehensive treatment to reduce progression and premature mortality. Exploring the biological pathways that could account
Electroconvulsive therapy (ECT), which has been in use for 75 years, is an important treatment for severe and treatment-resistant depression. Although it is acknowledged as the most effective acute treatment for severe mood and psychotic disorders, it remains controversial because of misperceptions about its use and lack of familiarity among health care professionals about modern ECT technique. The authors present an illustrative case of a patient for whom ECT is indicated. They review the basic and clinical science related to ECT's mechanism of action and discuss clinical issues in the administration of a course of ECT, including the consent process.
Five Steps to Improving Patient Access Judy Capko, May 21, 2013 Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.