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Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
This can lead to inappropriate treatment, and consequent lack of improvement or worsening of the patient's psychiatric condition. Some markers of bipolar depression (as opposed to unipolar, or major depression) include atypical symptoms (i.e., increased sleep or appetite), psychotic depression, early age of symptom onset, treatment resistance to antidepressants, and a family history of bipolar disorder [57]. Hypomania often is overlooked in the general psychiatric population, as patients often dismiss symptoms that do not disrupt (or even enhance) their functioning. Clinicians may not inquire about episodes of elevated mood. Hypomania after delivery may be misconstrued as normal joy related to the birth of a child [32].
Ask About Family History
Published in Scott A. Simpson, Anna K. McDowell, The Clinical Interview, 2019
Scott A. Simpson, Anna K. McDowell
A good family history adds value to the clinical interview. For example, a patient with a family history of mania, schizophrenia, or lithium treatment is at higher risk for bipolar depression—a condition that requires different treatment than unipolar depression.1 Patients with a family history of suicide are at increased risk for impulsivity, interpersonal dysfunction, self-harm, and suicide themselves.2 Asking about the family history helps the clinician better understand the patient’s background and upbringing. The family history might also inform the patient’s thoughts, fears, and preferences around treatment. Clinicians can gain a more complete and personal sense of their patients, while patients feel better understood.
Assessment, Diagnosis, and Case Conceptualization With Couples
Published in Len Sperry, Katherine Helm, Jon Carlson, The Disordered Couple, 2019
Jennifer is a 32-year-old second-generation Hispanic female with a history of Bipolar Disorder. She has been married for six years and has no children. Jennifer sought out couple therapy because she was angry, dissatisfied, and considering divorce, yet wanted her marriage to work. Her Caucasian husband, Jerrod, is a 37-year-old successful engineer and is emotionally distant and very proper. He is also rigid and not prone to compromise. Jennifer was diagnosed with bipolar II disorder and histrionic personality traits five years ago. While she did not respond well to previous medication trials for her bipolar depression, she believes that individual therapy has been somewhat helpful in calming her moods. Jennifer believes that Jerrod’s response to her mood swings for most of their marriage is that “of course, he’s concerned but he doesn’t really show it.” Because her mental condition prevents her from working full-time, Jennifer is financially dependent on Jerrod.
Efficacy of dextromethorphan for the treatment of depression: a systematic review of preclinical and clinical trials
Published in Expert Opinion on Emerging Drugs, 2021
Amna Majeed, Jiaqi Xiong, Kayla M. Teopiz, Jason Ng, Roger Ho, Joshua D. Rosenblat, Lee Phan, Bing Cao, Roger S. McIntyre
Interestingly, Lee et al. (2017) found that DXM 30 mg/d + VPA (50–100 ug/ml in plasma) could improve antidepressant symptomatology, but only in patients who had the COMT Val158Met polymorphism (Val/Met heterozygotes) [48]. COMT is a candidate gene for BD, implicated primarily in the dopamine and norepinephrine degradation pathways in the frontal cortex; the Val158Met single-nucleotide polymorphism is postulated to decrease the allele activity level and increase susceptibility to bipolar depression and BD [65,66]. As such, it is possible that intermediate enzymatic activity (i.e. as indicated by Val/Met heterozygous allele) through DXM 30 mg/d have an optimal effect on dopamine activity for antidepressant effects [48]. Similarly, Lee et al. (2020) reported that upon stratifying patients for the dopamine receptor 2 genes (DRD1/ANKK1 TadIA), DXM also improved manic symptoms in BD [46]. Manic symptoms during bipolar depression are associated with greater lifetime illness severity, and increased frequency of cycling and suicide attempts when compared to bipolar depression without mania [46]. While preliminary studies, these results not only suggest a mechanism for DXM (i.e. dopamine signaling), but also highlight candidate genes in MDD and BD for personalized DXM use.
Bipolar depression: the clinical characteristics and unmet needs of a complex disorder
Published in Current Medical Research and Opinion, 2019
Roger S. McIntyre, Joseph R. Calabrese
Bipolar disorder is a chronic and complex mood disorder that is characterized by an admixture of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with significant subsyndromal symptoms that commonly present between major mood episodes1. Ranked among the leading causes of worldwide disability2, bipolar I disorder has been consistently associated with significant medical and psychiatric comorbidity, premature mortality, high levels of functional disability and reduced quality of life3. The essential feature of bipolar I disorder requires the occurrence of at least one fully syndromal lifetime manic episode, although depressive episodes are common4. Bipolar II disorder requires the occurrence of at least one hypomanic episode and one major depressive episode; it is no longer considered a milder form of bipolar disorder as it is associated with considerable time spent depressed and with functional impairment that accompanies mood instability4. Bipolar disorder with mixed features is a complex presentation in which a mood episode from either the manic or depressive pole is complicated by the presence of subsyndromal but clinically significant symptoms from the opposite pole. Patients with bipolar depression have greater morbidity and mortality than patients with bipolar mania, with depressed patients having a higher risk of suicide, interepisode panic attack and psychosis5.
Healthcare resource utilization, costs and treatment patterns in patients with bipolar disorder treated with lurasidone or cariprazine
Published in Journal of Medical Economics, 2021
Huan Huang, Luke Schmerold, Carole Dembek, Qi Fan, Christopher Dieyi, G. Rhys Williams, Antony Loebel
Bipolar disorder is a chronic affective condition characterized by the presence of recurring manic or hypomanic episodes that alternate with depressive episodes1. Bipolar I disorder is defined by at least one manic episode while bipolar II disorder is defined by at least one hypomanic episode2. The depressive phase of bipolar disorder (bipolar depression) accounts for the majority (70%) of symptomatic time in bipolar I disorder3 and significantly impacts morbidity, mortality and disability4,5. Bipolar depression is the main cause of psychosocial and occupational impairment in bipolar disorder5.