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Mood Disorders in 3 Clinical Reports

Mood Disorders in 3 Clinical Reports


  • 3 reports on mood disorders focus on phenotypic boundaries of bipolar disorders, suicide risk and prevention, and comorbid ADHD and depression. Scroll through the slides for links to each report.

  • Introduction to 3 Clinical Reports on Mood Disorders
    Depressive disorders and bipolar and related disorders have their own chapters in DSM-5, but the challenges for diagnosing and treating these disorders remain the same. Some of the most common challenges include the diagnosis of a mood disorder, especially a bipolar disorder, and the assessment and management of comorbidities and suicidalities in patients with a mood disorder. In this Special Report on mood disorders, chaired by by Keming Gao, MD, PhD, the authors of the 3 articles have attempted to address these issues.


  • 1. Phenotypic Boundaries of Bipolar Disorder
    There is no substitute for understanding one’s patient as an individual, and treating accordingly, keeping in mind the possibility that not all psychosis is schizophrenia and that moodiness may or may not indicate a place in the bipolar spectrum. With this in mind, Dean F. MacKinnon, MD, uses 2 patients as examples to illustrate phenotypic differences in bipolar disorders. He concludes “soft” symptoms are not easily discerned. Clinicians should pay close attention to the “soft” symptoms during interviews.


  • Significance for the practicing psychiatrist: The elusive nature of bipolar diagnoses, especially atypical forms of bipolar disorder, requires an understanding of the patient's phenotype and functioning. Because it is a discrete disease entity, bipolar disorder is often difficult to fit cleanly into formal diagnostic categories. For a larger view of this slide, click here.


  • Lessons Learned: Suicide
    Among all the psychiatric conditions, bipolar disorder has the highest risk for suicide and suicide attempts. To reduce deaths by suicide in patients with bipolar disorder, the International Society for Bipolar Disorder Task Force on Suicide Risk and Prevention in Bipolar Disorder made a collaborative effort to study the risk factors for suicide and suicide attempt and to develop strategies to assess and manage suicide risk. In their article on suicide risk and prevention in bipolar disorder, Ayal Schaffer, MD, and Manuel Sanchez De Carmona, MD, share some findings from this collaboration. The authors first review the prevalence of suicide and suicide attempt and summarize the risk factors for suicide. They also provide a specific clinical model for bipolar disorder suicide risk assessment, and propose strategies for managing suicide risk.


  • Significance for the practicing psychiatrist: Issues related to suicide risk are especially important to keep in mind, especially because the risk of death by suicide is over 10-fold greater in people with BD. The impact of the illness of BD on suicide rates is greater in women than men. Lithium and other treatment for BD have been shown to lower rates of suicide attempts and deaths in people with BD. For a larger view of this slide, click here.


  • Comorbid ADHD and Depression
    A significant number of patients with a mood disorder, especially those with bipolar I disorder, also have ADHD. Commonly used medications for ADHD have the potential to worsen anxiety symptoms and provoke mania or hypomania. In adults, episodes of major depressive disorder MDD cause significant morbidity and mortality, but when they occur with ADHD, such episodes are more prolonged, more likely to result in suicidal behaviors and hospitalizations, and more likely to convert from unipolar to bipolar mood disorders.

    W. Burleson Daviss, MD, and Joseph B. Bond, MD, review the prevalence, assessment, and treatment of comorbid ADHD and depression. Their review not only provides an update on this important topic, but also helps clinicians understand the challenges and unmet needs in this population. They discuss potential risk factors related to comorbid ADHD and depression, strategies for proper diagnosis, and treatment approaches.


  • Significance for the practicing psychiatrist: Comorbid ADHD and depression frequently occur together, often leading to long-term impairment and treatment challenges. The general strategy for psychopharmacology and therapy is to treat the more severe and impairing condition first before treating the second condition. For a larger view of this slide, click here.

Comments

Muy buen artículo.-Muchas gracias.-

Samuel @

Good article. Sometimes the individual themselves and the psychiatrist are eager for a label and diagnosis to treat and make the symptoms go away. There is no replacement for a thorough physical , social , and mental health history and assessment which takes time. A therapeutic trusting relationship takes time to develop. Support systems and involvement of families take time , and often the individual has not received timely treatment because of denial and stigma, so relationships are stressed already. Sometimes depression is a precursor to a physical illness not yet diagnosed. People can be educated on their illness and creating self -awareness of their triggers. Suicide awareness and intervention is crucial at every point of contact . These all take time. Treating the whole person in the context of their life as it exists requires a team of caring professionals People who are severely ill and not functioning at all, drains our resources both professionally and personally. Prevention , education and reducing stigma of mental illnesses is a key to preventing such devastation in the aftermath of several breakdowns and is lacking. This affects our whole society and the costs are not only in dollars and cents

Brenda E @

Brenda E nice summary. I agree. Worthy goals for practice.

Richard Anthony @

Commendable reply - thank you Brenda! Your insight is well presented - sadly I see this situation frequently in our practice. Time is the platform for most healing but if not constructed with the right tools, time becomes empty and pointless as we see these days with virtually no employment, high costs of living and disjointed families.... jj

janey @

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