Bipolar Disorder

As I was driving to work on February 10, 2010, I listened to the National Public Radio host Melissa Block talking about how children labeled “bipolar” may get a new diagnosis. I was shocked that the chair of one of the DSM5 work groups, David Shaffer, MD, would discuss a controversial diagnostic topic with the media.

The ideal field test would study how the diagnostic manual will eventually perform under conditions most closely approximating its future everyday use. The goal is to avoid unpleasant surprises in translation from what has been written on paper to what is practiced in real life. No field test can ever approach the ideal.

A meta-analysis sheds new light on the safety and efficacy of antidepressants in the acute treatment of bipolar disorder.

The DSM does and must involve both science and pragmatism. It must use the science that is available, but it must also make countless judgment calls that are not grounded in solid empirical evidence-and surely it makes sense to consider practical consequences in doing the latter.

Every year, more than 1 million children are exposed to sexual or physical abuse or neglect in the US. The research summarized here clearly demonstrates that exposure to stress before adulthood can result in persistent effects on both mental and physical health.

There are feasible and replicable ways for caring adults to help heal themselves as well as the next generation through mass application of reflection and altruistic caring for the remaining offspring, whether in Sichuan, Gaza, New Orleans, or Haiti.

There is evidence that the combination of medication and psychotherapy improves outcomes for many psychiatric illnesses. Among the several forms of psychotherapy that might be considered, cognitive-behavioral therapy (CBT) is the most extensively studied.

Which medications have typically been used as first-line treatment for acute mania? Is comorbidity the rule or the exception in patients with bipolar disorder? These questions and more in this week's quiz.

This is both an exciting and challenging time to be a child and adolescent psychiatrist. New findings are changing our knowledge of childhood psychopathology. This Special Report discusses current developments in diagnosis, treatments, and problems for children and adolescents.

Designers of descriptive diagnostic criteria for mental disorders face some of the same problems as fishermen. Fishermen, like nosologists, want to capture not just any fish but a particular kind. Fishermen deal with this problem in various ways.

Of the more than 250 million prescriptions written for psychiatric drugs in 2009 in this country, Xanax is the by far most popular. Nearly 50 million prescriptions were written for this benzodiazepine or its generic form last year.

What's the rate of bipolar spectrum disorder in children who have one parent with bipolar disorder? What methods are used to test for cognitive deficits in patients with bipolar disorder? These and more in this week's quiz.

Is combination therapy with lithium and valproate more effective in preventing relapses in patients with bipolar I disorder than monotherapy with either drug alone?

Are psychiatrists agents of the police or doctors who care for the sick? Thomas Szasz raised this question 50 years ago in his iconic “The Myth of Mental Illness.” Psychiatry has changed in the ensuing decades, but Szasz’ question is still relevant. Why?

In the debates around DSM-5, a central figure has been Allen Frances, whose views seem to elicit sympathy from many unhappy with the DSM system (the 4th edition of which Dr. Frances led).

According to the 2009 Roundtable on Bipolar Disorder in Children and Adolescents, a diagnosis of pediatric bipolar I disorder should be considered dependent on what factors? This and more in this week's quiz.

A small percentage of educators use their position of power to sexually exploit their students. While it is assumed that men are often responsible for this type of behavior, in recent years, a number of high-profile cases of female educator sexual misconduct have been covered by the media.

While I sit in the third row of my synagogue on Saturday morning, reciting the traditional portions of the Sabbath service, I have running through my mind an additional and more intensely felt prayer-that none of my fellow congregants will approach me later to discuss their personal psychiatric care.

An Overview of Antipsychotic Use in Older Adults

The contents of this volume are, as the cover emphasizes, “real stories from real people.” Clinicians who practice in a setting that allows time to really listen to patients have already heard these stories. These would be clinicians who have learned that listening to small details in a patient’s history helps one recognize patterns not described in the DSM.

Houston, we have a problem. There is a critical shortage of psychiatrists. And the problem is not in Houston alone-it includes the entire state of Texas, and every other state in the union (Mid-town Manhattan, Boston’s Beacon Hill, and Sacramento Street in San Francisco might be exceptions).

Researchers who have spent their careers studying schizophrenia and mood disorders might be forgiven a bit of “biomarker envy.” At long last, it seems that the neurologists and neuropsychiatrists have developed some fairly sensitive and specific “lab tests” for Alzheimer’s Disease (AD).

I offer all of this as a way of describing how I became involved in intensive psychotherapeutic efforts with several adolescents who I then continued to see, often for many years following their inpatient experiences.

Fads in psychiatric diagnosis come and go and have been with us as long as there has been psychiatry. The fads meet a deeply felt need to explain, or at least to label, what would otherwise be unexplainable human suffering and deviance.

When I was an undergraduate studying molecular biology in the early 1990s when the Human Genome Project had just begun, my required coursework included several lectures on the ethical implications of sequencing, understanding, and ultimately being able to manipulate the “code of life.”

Many have challenged the claim of the APA/DSM-5 Task Force that the current process is the most “open process in the history of the manual.” Few have actually provided an argument or evidence of why this might, or might not, be so. What has changed dramatically in the DSM process since DSM-IV in 1994, and even DSM-IV-TR in 2000, is the rise of Internet culture and the “blogosphere.” What does this have to do with DSM-5?

As an officer of the APA, I was one of the prime movers of the limitations on, and vetting of, potential participants in the preparation of the DSM5.

Bipolar disorder is recognized as a serious disorder. It has an adverse impact on many areas of a child’s development-including cognitive, emotional, and social functioning. Children with BD are at significant risk for substance use and suicidality. Further identification of effective treatments is a pressing public health concern.