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Bipolar Disorder
Published in Charles Theisler, Adjuvant Medical Care, 2023
Bipolar disorder, also known by its older name of manic depression, is a mental health condition that causes dramatic mood swings that include emotional highs (mania or hypomania) and lows (depression). This results in extreme shifts in mood with corresponding fluctuations in energy and activity levels. Patients can have manic episodes, depressed episodes, or mixed episodes. These episodes may last several weeks or months, with periods of stability in between. There are four types of bipolar disorder and patients are at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.1 The number one long-term treatment goal of bipolar disorder is stability. Despite the number of medications and psychotherapy techniques, the relapse rate is more than 70% over five years.2
Mood and Anxiety Disorders
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Tricia L. Chandler, Fredrick Dombrowski
Those who have BDI can have long-term major depression that abates for a few weeks of mania periodically, more manic episodes than depressive episodes, or rapid cycling of the extremes in moods. Those with mixed episodes have worse long-term outcomes than those with either depressive or manic episodes (Baldessarini et al., 2010; Dodd et al., 2010). Psychotic features can occur during the manic stage due to sleep deprivation, lack of nutrition during the mania, and/or using illicit substances.
Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
Bipolar disorder, type I (BAD I) is a severe form of bipolar disorder defined by at least one lifetime manic or mixed episode. Mixed episodes are characterized by simultaneous manic and depressive symptoms. The lifetime prevalence estimate is 1% for BAD I [32]. Men and women are affected at equal rates. Bipolar disorder, type II (BAD II) is characterized by episodes of depression and hypomania. The lifetime prevalence estimate is 1.1% for BAD II. Women with BAD II outnumber men by a ratio of approximately 2:1 [33]. The average age of onset of bipolar disorder is in the late teens to early twenties, placing affected women at high risk for mood episodes during their reproductive years. Hormonal fluctuations associated with reproductive events have been demonstrated to affect the course of bipolar disorder, with vulnerable periods occurring during the luteal phase of the menstrual cycle and during perimenopause, in addition to the postpartum period [34].
Pharmacotherapy for bipolar disorder in adults with high-functioning autism
Published in Expert Opinion on Pharmacotherapy, 2022
Salvatore Amadori, Margherita Barbuti, Giulio Perugi
Antipsychotics are effective during acute manic or mixed episodes with severe agitation or psychotic features, or when comorbid tic disorders are present. Some peculiar abnormalities of the serotonergic system have been shown in ASD individuals, such as high serum serotonin (5-HT) levels [71], high 5-HT concentration in the cortex [72], altered brain 5-HT synthesis, reduced 5-HT2A receptor binding capacity, and reduced serotonin transporter (5-HTT) binding capacity in the cingulate cortex [73]. Although these findings are not always replicated, they represent one of the most interesting lines of research on the pathophysiology of ASD, and provide the rationale for the selection of antipsychotic drugs with dopamine receptor antagonism combined with serotonergic activity. Indeed, agents highly selective on 5-HTT and 5-HT2A receptors are considered the first choice in HFA [74,75]. Although risperidone and aripiprazole have been the most investigated medications, also chlorpromazine present a complex mechanism of action including antagonism on 5HT-2A receptors and could be effective in the treatment of manic or mixed episodes in individuals with HFA-BD [30].
Factors influencing lithium versus valproate prescription preference in the maintenance treatment of bipolar patients: a report from the Italian Early Career Psychiatrists (SOPSI-GG)
Published in International Journal of Psychiatry in Clinical Practice, 2021
Massimiliano Buoli, Eleonora Gattoni, Enrico Collantoni, Alessio Maria Monteleone, Marco Solmi, Luisa Longo, Michele Ribolsi, Jacopo Santambrogio, Francesco Saverio Bersani, Andrea Aguglia, Gianluca Serafini, Maria Salvina Signorelli, Bernardo Dell’Osso, Mario Luciano, Silvana Galderisi
The total sample included 252 young mental health professionals: 116 males and 136 females with a mean age of 30.98 years ± 3.89. Results of descriptive statistics are reported in Table 1 (demographic and professional features, education and knowledge of lithium) and Table 2 (patterns of prescription practice for BD). Of note, 17.2% of the total sample declared to have received no education about lithium compared to 69.8% that declared to having received theoretical plus practical education, 39.4% and 34.1% of the participants respectively stated that scientific publications and colleagues were the main source of their education about lithium, and 28.7% of the total sample was poorly satisfied about the received education on lithium. In addition, valproate resulted to be the preferentially prescribed mood stabiliser in manic and mixed episodes (respectively 51.2% and 65.7% of the total sample). In contrast, with regard to lithium, most ECPs selected this compound for BD type 1 (87.3%), declared periodic blood exams as main barrier for its prescription (61.3%) and they decreased lithium doses in case of pregnancy (59.9%).
Homocysteine, chronotype and clinical course in bipolar disorder patients
Published in Nordic Journal of Psychiatry, 2020
Meral Gunes Ozdogan, Esat Fahri Aydin, Mehmet Fatih Ustundag, Hacer Akgul Ceyhun, Elif Oral, Ebubekir Bakan
Our results were in line with a previous study showing elevated blood Hcy levels in alcohol use disorder patients with mixed episodes [28]. However, in 2013, Permoda-Osip et al. published a study of 112 BD patients with depressive episodes, which showed that high levels of Hcy were found more frequently during depressive episodes [29]. A recent meta-analysis showed that Hcy levels were elevated in BD patients during mania and euthymia when compared to healthy controls [30]. In our results, the number of mixed episodes was significantly associated with HHcy. Patients who experience mixed episodes tend to have a more severe form of BD with a poorer prognosis that is more commonly associated with a risk of suicide, substance abuse, comorbid conditions and poorer treatment outcomes than those who experience other types of episode [31–33]. Both Hcy and its oxidative metabolite, homocysteic acid, are NMDA receptor agonists, and the long-term activation of NMDA receptors due to HHcy would result in an increased calcium ion influx that exerts neurotoxic effects. This relationship connects Hcy to the known role of dysregulated glutamatergic activity in the pathology of BD [6,27]. Neurotoxic effects of Hcy may cause affective instability, and this could be a possible explanation of the relationship between HHcy and the number of mixed episodes.