Bipolar Disorder

Do not be surprised if you hear more about hybrid models of psychiatric diagnoses included in DSM-5. The categorical and dimensional model approaches are 2 sides of the same coin as you look at the same patient from 2 different angles.

Anti-psychiatry proponents forget it is widely recognized that the DSM is a provisional diagnostic system pending progress in better understanding uniquely human disorders of our most complex organ.

The role of subtyping and bipolarity in TRD was discussed in Part 1 of this 2-part article. Here we review a number of the most common confounding factors of TRD but limit our scope to comorbidities that can be directly addressed and treated by psychiatrists.

Ongoing advances in functional brain imaging will permit studies on postulated roles of magnetic fields, biophotons, and macroscopic highly coherent quantum field effects on normal brain functioning and mental illness.

Effective personalized treatment recognizes bipolar disorder as a biopsychosocial disorder, but mood-stabilizing medications are the backbone of treatment. These medications fall into 3 categories: lithium, antikindling/antiepileptic agents, and second-generation antipsychotics.

Our current diagnostic system is based more on subjective clinical judgments and less biological psychiatry. There is not one way to develop symptoms of schizophrenia or bipolar disorder or autistim or OCD.

The current system of payment for mental health care in the US can lead, or even incentivize, clinicians to focus on and code for Axis I disorders and their more readily reimbursed psychopharmacological treatment approaches.

The side effect of persons with psychiatric illness like bipolar disorder going off medication can be destructive. This patient had been in trouble with the local police, who saw her as a troublemaker and a menace.

DSM-5 better captures the essence of narcissistic personality disorder (NPD) than previous versions did. The hypervigilant NPD subtype is the least understood but seen the most often in patients.

There is rapidly escalating interest in drugs that target the glutamatergic neurotransmitter system, especially NMDA receptor modulators. The hope is that they will fill the large unmet need for rapid-acting antidepressant medications with efficacy in treatment-resistant depression.

Importantly for lay and clinician readers alike, the book Monkey Mind: A Memoir of Anxiety reads as humor-laced triumph with many lost battles along the way rather than enduring unrelenting tragedy.

The California Supreme Court’s decision in the Tarasoff case over 30 years ago has become a standard part of mental health practice. This case influenced the legal requirements governing therapists’ duty to protect third parties in nearly every state in the US.

In light of our problems and uncertainties about the state of current psychiatry, or perhaps because of them, what might describe good psychiatry? Following are some suggestions for what we, as psychiatrists, can do.

Prejudice is a net that ensnares not only those who suffer from severe psychiatric illness, but also many of us who care for individuals with bipolar and other disorders.

The Suicide Risk Screening Alert is a clinical tool that assists the psychiatrist and nonpsychiatric physician in identifying patients at risk for suicide during brief medication management appointments.

ADHD has been significantly associated with a primary diagnosis of impulse control disorder and bipolar disorder and most commonly associated with social phobia and major depressive disorder. Details here. . .

Dr Michael Thase touches on an APA presentation about newer applications of cognitive therapy for disorders such as schizophrenia and bipolar disorder.

Staying empathic and keeping the conflict within the patient instead of between the patient and health care provider, is a key to successful management.

The paradigm for modern psychiatry is evidence-based medicine (EBM)-it represents proven treatments for defined diagnoses. But there are major problems with this position, starting with the fact that while they are superior to placebo, evidence-based treatments too often are ineffective.

In a recent interview on 60 Minutes, Harvard psychologist Irving Kirsch, PhD, commented, “the difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.”

Insight can be assessed in the course of a typical evaluation or follow-up interview with augmentation by questions borrowed from any of the validated insight rating scales.

When thinking about recent advances in psychopharmacology, we often point to new molecules with similar mechanisms of action but with better safety and tolerability profiles, or to molecules with novel mechanisms that effect positive change greater than that with existing treatments.

Adequate treatment of the underlying psychiatric illness consistently appears to be the most effective use of medication in suicidal patients.

Several studies have been undertaken to test the efficacy of drugs in the management of aggression and hostility in patients with schizophrenia and other mood disorders.

The diagnostic boundary between Major Depressive Disorder and Bipolar II Disorder is one of the most difficult and also one of the most important in psychiatry.

During their time in Ayacucho, these visiting psychiatrists learned that American psychiatric training has wide-reaching cultural value.

With DSM-5 scheduled for publication a little more than a year from now, we may safely assume that, barring unannounced surprises from, say, the APA Scientific Review Committee, what we will see on the DSM-5 Web site is what we will get. With that in mind it’s time to review what we will indeed get.

The responsibility for improvement was placed on psychiatrists: diagnostic skills had to be improved and patients and their families and caregivers as well as the general public needed to be better educated about the disorder and treatment options.

Three twin studies published between 1977 and 1995, which provided the main body of knowledge on heritability of autism, showed a concordance rate of 72% for a total of 36 monozygotic pairs and a concordance rate of 0% for 30 dizygotic pairs.

In this article the topic addressed are the primary reasons for the American public’s disenchantment with psychiatry; how the profession ought to address these issues; and how we need to replace the DSM’s categorical system with one that is clinically useful for both clinicians and patients.