Bipolar Disorder

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.

There are dozens of books on the market aimed at helping the general public recognize depression; there are far fewer that focus specifically on the more subtle forms of bipolar disorder. This disparity has its clinical parallel in the over-diagnosis of unipolar depression among patients who ultimately prove to have a bipolar disorder. Indeed, survey data suggest that there is typically a 7-year delay in the correct diagnosis of bipolar spectrum disorder.

The prevalence and debilitating nature of some of the personality disorders has impeded the study of psychopharmacology in these conditions. However, important advances have been made in the last several years.

This article focuses on data concerning the efficacy of mood stabilizers in the treatment of BPD.

The evidence showing a relationship between mental disorders in childhood and adulthood has increased in the last several decades.

When assessing a sleep-related problem in a psychiatric patient, investigating all possible causes may be more helpful than assuming the complaint is a result of medication or the underlying condition.

With expansion of the concept of bipolar disorder (BD), there has been concern about the potential for overdiagnosis. However, diagnostic errors in bipolar disorder are currently skewed towards underdiagnosis.

The psychiatric community has a need for diagnostic and predictive tests. Some recent techniques have just become available for clinical care.

Antidepressants may have a protective effect on the hippocampal atrophy seen in patients with severe, untreated depression. This atrophy may be caused by an overabundance of glucocorticoids.

A discussion of new neurobiologic discoveries that bear the promise not just of controlling but of reversing protean levels of damage.

Reexamining the Link Between Antidepressantsand Suicidality in Children and Adolescents

BasicNeeds is a program in developing countries that works with individuals with mental illness or epilepsy, their families, and their communities to establish accessible treatment programs, satisfy basic needs, and reduce social marginalization and stigma.

The idea that schizophrenia and bipolar disorder might be caused by infection is not new. New research on infectious agents in patients with schizophrenia and bipolar disorder has implications for psychiatric clinicians.

Defining "stress" and how it is expressed and managed in both psychiatrists and patients is a difficult proposition. This Special Report focuses on stress and the middle ground between the impulse to say there is no such thing as “stress” and the tendency to describe many explicit addressable issues under the monolithic term "stress."

An overview of the articles in this Special Report on psychopharmacology.

Pediatric psychosomatic research shows that emotional, behavioral, and psychiatric symptoms are found more often in children and adolescents with chronic illnesses than in healthy children.

Damage can take biologic, syndromic, social, and personal form, with correlations among the various levels of damage.

The perinatal period is a high-risk time for some women to experience a new onset or exacerbation of a mood disorder that may require emergency psychiatric care.

A discussion of the recent research on the use of antidepressants in bipolar disorder (BD), and the methodologic principles that should guide this aspect of psychopharmacology.

All physicians need to be aware of the medicolegal aspects of practicing medicine, but because emergency psychiatrists must sometimes treat patients against their will or act as consultants to determine capacity, they must be especially vigilant when dealing with the overlap between law and medicine.

Psychiatric advance directives (PADs) allow persons to authorize proxy decision makers and document advance instructions or preferences about future mental health treatment in the event of a crisis. The intent of PAD legislation is to enhance treatment autonomy for persons with severe mental illnesses (such as schizophrenia, bipolar disorder, and major depression) who anticipate periods of decisional incapacity associated with illness relapse.