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
Impairments in facial emotion recognition (FER) have been reported in bipolar disorder (BD) during all mood states. FER has been the focus of functional magnetic resonance imaging studies evaluating differential activation of limbic regions. Recently, the 1-C subunit of the L-type voltage-gated calcium channel (CACNA1C) gene has been described as a risk gene for BD and its Met allele found to increase CACNA1C mRNA expression. In healthy controls, the CACNA1C risk (Met) allele has been reported to increase limbic system activation during emotional stimuli and also to impact on cognitive function. The aim of this study was to investigate the impact of CACNA1C genotype on FER scores and limbic system morphology in subjects with BD and healthy controls.|Thirty-nine euthymic BD I subjects and 40 healthy controls were submitted to a FER recognition test battery and genotyped for CACNA1C. Subjects were also examined with a 3D 3-Tesla structural imaging protocol.|The CACNA1C risk allele for
Effective, long-term therapy for bipolar disorders is a critical goal of mental health care, but achieving this goal is complicated by numerous factors in real clinical settings. The aim of this study was to investigate dropout patterns and their associated factors in patients with bipolar disorders.|The study participants were 275 patients with DSM-IV bipolar disorders, receiving planned maintenance treatment among patients at the MoodDisorders Clinic of Seoul National University Bundang Hospital between January 2005 and December 2007. The rates of dropout in patients were prospectively examined for 3 years. The factors affecting the dropouts were analyzed using a Cox regression model.|The dropout rates were 10.9%, 20.4%, 24.7%, 33.8%, 44.0%, and 50.2% at 1, 3, 6, 12, 24, and 36 months after treatment entry, respectively. The dropout rates increased rapidly during the first three months and slowed after 12 months. Past psychotic symptoms (HR 0.523, 95% CI 0.339-0.807), longer
Our aim was to identify the diagnostic profile of patients classified as 'false positives' on two bipolar screening measures; the Mood Swings Questionnaire (MSQ) and the MoodDisorders Questionnaire (MDQ).|A total of 1534 patients attending the Black Dog Institute Depression Clinic completed the MSQ-46, and a smaller subset of 852 completed the MDQ. All patients underwent clinical assessment by one or more Institute psychiatrists.|Using clinical assignment (i.e. bipolar vs. unipolar) as the criterion measure for assessing the screening measures, the overall agreement rates were 84% for the MSQ-46 and 74% for the MDQ. Patients identified as 'false positives' were most likely to be clinically diagnosed as having a unipolar non-melancholic depression (37% for MSQ-46; 46% for MDQ), or a primary anxiety condition with secondary non-melancholic depression (19% for MSQ-46; 15% for MDQ). In addition, within the unipolar non-melancholic group, 46% of the MSQ-46 assigned false positives and 63%
Sleep problems and circadian rhythms disturbances are common in many psychiatric disorders, with the most often-reported sleep problem in most cases being insomnia. In this paper, the main findings about sleep disturbances(features and therapy) and other biorhythm disturbances (biological timekeepers, CLOCK genes, GSK3, melatonin, hypothalamo-pituitary-adrenal axis, body temperature) are reviewed in relation to schizophrenia, mood and anxiety disorders.
The effects of brain AngII (angiotensin II) depend on AT(1) receptor (AngII type 1 receptor) stimulation and include regulation of cerebrovascular flow, autonomic and hormonal systems, stress, innate immune response and behaviour. Excessive brain AT(1) receptor activity associates with hypertension and heart failure, brain ischaemia, abnormal stress responses, blood-brain barrier breakdown and inflammation. These are risk factors leading to neuronal injury, the incidence and progression of neurodegerative, mood and traumatic brain disorders, and cognitive decline. In rodents, ARBs (AT(1) receptor blockers) ameliorate stress-induced disorders, anxiety and depression, protect cerebral blood flow during stroke, decrease brain inflammation and amyloid- neurotoxicity and reduce traumatic brain injury. Direct anti-inflammatory protective effects, demonstrated in cultured microglia, cerebrovascular endothelial cells, neurons and human circulating monocytes, may result not only in AT(1)
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.