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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
Women with bipolar disorder are particularly vulnerable to mood episodes in the postpartum period. In women with a known history of bipolar disorder, medication maintenance during pregnancy and postpartum is often warranted. Mood stabilizers are not generally interchangeable and their risk/benefit profiles are also individualized. The only mood stabilizing medication which is unequivocally contraindicated in pregnancy is valproic acid. Treatment decisions should be made on an individualized basis, and maintenance of euthymia should again be prioritized.
Bipolar Disorder in Children and Young People
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
It is currently thought, based on available evidence, that bipolar disorder is a chronic and, at times, disabling condition with poor rates of remission (Ferrari et al., 2016). However, with the right combination of treatment, it is possible for people to experience periods of stability, and studies have shown that approximately one-third of people diagnosed can experience euthymic mood up to 80% of the time (Birmaher, 2017).
ECT after completion of the index course
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
Dew and McCall (2004) noted that m-ECT is highly effective and well tolerated in acutely ill patients. It is a useful and cost-effective modality that reduces the need for rehospitalisation. Sartorius and Henn (2005) emphasised that ECT was a pru-dent tool for keeping patients with major depression in remission. It is the only treatment that yields extended periods of euthymia in patients with treatment-resistant mania (Tsao, Jain, Gibson, Guedet and Lehrmann., 2004). and that m-ECT was a safe alternative to medication alone (Swoboda, Colnca, Konig, Waanders and Hansen, 2001).
Objective and biological markers in bipolar spectrum presentations
Published in Expert Review of Neurotherapeutics, 2019
Trisha Chakrabarty, Lakshmi N. Yatham
Decreased BDNF levels are seen in MD and BD. This is apparent in both when acutely symptomatic, but appears to normalize in euthymic states [128]. One study found that BDNF levels were lower in BDI depression compared to MDD, and proposed a cut-off level which could discriminate between BD and MDD with 88% sensitivity and 90% specificity [129]. However, another study found no significant differences in BDNF between euthymic MDD, BDI, BDII and currently depressed MDD [130]. The stage of illness appears to be related to BDNF levels in BD, with first episode patients having no alteration in BDNF levels while those that had multiple mood episodes had significantly lower levels [131]. Further, age-related decreases in BDNF levels appear to be more pronounced in BD I patients relative to healthy comparators [132].
Lurasidone compared to other atypical antipsychotic monotherapies for bipolar depression: A systematic review and network meta-analysis
Published in The World Journal of Biological Psychiatry, 2018
Michael Ostacher, Daisy Ng-Mak, Pankaj Patel, Dionysios Ntais, Max Schlueter, Antony Loebel
In 2010, the World Health Organisation estimated that bipolar disorder affected 58.9 million people globally (Whiteford et al. 2015), with the lifetime prevalence rate estimated at 2.4% (Merikangas et al. 2011). Patients with bipolar disorder experience periods of mania and depression, as well as stable periods of euthymia (Murphy & Sahakian 2001). Symptomatic episodes associated with bipolar disorder are both disabling to patients and burdensome to caregivers and society, resulting in substantial productivity losses (Miller et al. 2014). During periods of even minor depression (i.e. presence of depressive symptoms below the threshold for major depressive disorder), patients’ psychosocial functioning is impaired and intensifies as depression severity increases (Judd et al. 2005). Accounting for roughly 67% of patients’ symptomatic time, depression contributes more significantly to productivity losses than mania (Miller et al. 2014). During depressive episodes of bipolar disorder, patients miss more days of work (Dilsaver et al. 1997; Simon et al. 2008), have a higher risk of suicide (Dilsaver et al. 1997; Hirschfeld 2004) and have more severe interpersonal relationship disruption (Hirschfeld 2004; Frye et al. 2014).
The clinical role of well-being therapy
Published in Nordic Journal of Psychiatry, 2018
Jenny Guidi, Chiara Rafanelli, Giovanni A. Fava
An important characteristic of WBT is self-observation of psychological well-being associated with specific homework (i.e. self-therapy). Such perspective is different from interventions that are labeled as positive but are actually distress oriented. The patient is introduced to the concept of self-therapy from the very beginning, since only continuous training may sustain new insights and make them lasting, even after treatment ends. Another important feature of WBT is the assumption that imbalances in well-being and distress may vary from one illness to another and from patient to patient [3]. The pursuit of euthymia [8] can thus only be achieved with a personalized approach that characterizes the treatment protocol and requires a comprehensive initial evaluation and a collaborative therapist/patient relationship. Further, the manualization of WBT [17] may facilitate its individualized application and the insights gained by clinicians and investigators may refine its current use and indications. Whenever tested in a controlled fashion, WBT has been found to add incremental efficacy to the clinical approach, but its full clinical applications are still unexplored. Areas of potential development deal with treatment format (e.g. individual, group, family oriented, and computer-assisted), as well as new fields of application of WBT, such as preventive actions especially in childhood and adolescence and psychotherapy in the setting of medical disease.