Bipolar Disorder

The problem of treatment resistance in bipolar disorder begins with its definition. Characterizing the phases of bipolar disorder as manic, mixed, hypomanic, or depressed does not do justice to the reality for many persons with this disorder.

The need for better tools, as well as better use of existing tools, to measure treatment response in clinical trials was a principle focus of the 46th annual NIMH-sponsored NCDEU (New Clinical Drug Evaluation Unit) meeting, held June 12-15 in Boca Raton, Fla. Improved clinical research techniques are needed to better separate treatment effect from placebo response, to distinguish between active comparators, and to facilitate development of novel treatments, according to several presenters at the conference.

The increase in youth violence and aggression in the past 50 years has been called an "epidemic." This epidemic has had a tremendous impact on society. From an economic and public health perspective, primary prevention of youth violence is obviously desirable.

The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.

Since children are a vulnerable population, ethical issues in the conduct of medication studies involving them are extremely important. We recently reported the results of a study that examined youths' and parents' attitudes about, and experiences with, participation in psychopharmacology treatment research.

In a presentation given at the midyear meeting of the American Epilepsy Society, Andres Kanner, MD cited studies from the literature showing that the rates of depression, anxiety, psychosis, and attention-deficit/hyperactivity disorder (ADHD) are significantly higher among persons with epilepsy than among the general population

Alcohol is the drug of choice for adolescents, with cigarettes and marijuana being second and third. Contrary to widespread belief, alcohol dependence is most common in 18- to 20-year-olds, with progressively decreasing rates of alcohol dependence in older age groups.

The longitudinal course of bipolar disorder (BD) is characterized by a low rate of recovery, a high rate of recurrence, and poor interepisodic functioning. There is a need to invoke a chronic disease management model (CDMM) when treating individuals with BD.

CBT is a comprehensive system of therapy that builds on core therapeutic values by using a wide range of reliable methods to produce cognitive and behavioral change.

Despite advances in our understanding of depression therapy, many patients with depression remain unresponsive to treatment. As many as 50% of patients who begin treatment with an antidepressant do not respond.

Your patient has pain and numbness that extends from the shoulder to the hand. You suspect a herniated cervical disk, but the MRI scan comes back normal. What else could the culprit be?

New findings in epidemiology, developmental psychiatry, and neuroscience offer the opportunity for a new perspective on the problems of juvenile delinquency and bring to bear the insights of modern psychiatry in the treatment and successful rehabilitation of juvenile offenders.

Friendship with patients, particularly those with serious mental illness, may seem anathema for a psychiatric ethicist, yet there is a long and rich history of physician-patient friendship in medical ethics.

DSM-IV-TR emphasizes that patients with borderline personality disorder (BPD) show a "instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts," and any five out of nine listed criteria must be present for the diagnosis to be made.

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

What does the term “polypharmacy” actually mean? Dr Pies likens polypharmacy to fire: just as the latter may either heat your house or burn it down, polypharmacy may either help or harm the patient.

A discussion of the pharmacologic management of bipolar depression, including emerging treatments and expert recommendations.

A look at how to use the spectrum concept to promote understanding and acceptance of bipolar II and soft bipolar diagnoses. In this article, you will find 5 tools for fostering what has been called “concordance” or, more simply, “buy-in.”

Although psychosis is rare in adolescent patients with anorexia nervosa restricting type, the possibility should be explored because it may be the underlying cause of the eating disorder.

There are still many questions about how to develop useful guidelines, introduce them into clinical practice, and measure their effectiveness. What does it mean to use a guideline in practice?

The past few years have seen substantial progress in recognizing and treating several of the subtypes of bipolar disorder. This Special Report addresses the diagnostic challenges and the different strategies for managing these subtypes.

A discussion of the many difficulties in treating patients with the rapid-cycling subtype of bipolar disorder, along with a history of the condition and the author’s treatment approach.

Three issues of current concern in bipolar II disorder include: diagnostic criteria for hypomania, diagnosis of mixed depression, and management of mixed depression.

Bipolar disorder I and II have the highest association with substance use disorder, compared with any other major psychiatric disorder. Treatment requires an integrated approach that includes specific psychotherapy as well as the use of medication.

A discussion of the development of the brain and whether neurobiology of the brain can play a role in predicting risk for future bipolar disorders and substance use disorders SUDs.