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Is Your Depressed Patient Bipolar?
J Am Board Fam Pract: first published as 10.3122/jabfm.18.4.271 on 29 June 2005. Downloaded from EVIDENCE-BASED CLINICAL MEDICINE Is Your Depressed Patient Bipolar? Neil S. Kaye, MD, DFAPA Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essen- tial, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treat- ment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdi- agnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive fea- tures and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifi- cally on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physi- cian can easily perform this assessment. Tools to assist the physician in daily practice with the evalua- tion and recognition of bipolar disorders and bipolar depression are presented and discussed. (J Am Board Fam Pract 2005;18:271–81.) Studies have demonstrated that a large proportion orders than in major depression, and the psychiat- of patients in primary care settings have both med- ric treatments of the 2 disorders are distinctly dif- ical and psychiatric diagnoses and require dual ferent.3–5 Whereas antidepressants are the treatment.1 It is thus the responsibility of the pri- treatment of choice for major depression, current mary care physician, in many instances, to correctly guidelines recommend that antidepressants not be diagnose mental illnesses and to treat or make ap- used in the absence of mood stabilizers in patients propriate referrals. -
Conflict, Arousal, and Logical Gut Feelings
CONFLICT, AROUSAL, AND LOGICAL GUT FEELINGS Wim De Neys1, 2, 3 1 ‐ CNRS, Unité 3521 LaPsyDÉ, France 2 ‐ Université Paris Descartes, Sorbonne Paris Cité, Unité 3521 LaPsyDÉ, France 3 ‐ Université de Caen Basse‐Normandie, Unité 3521 LaPsyDÉ, France Mailing address: Wim De Neys LaPsyDÉ (Unité CNRS 3521, Université Paris Descartes) Sorbonne - Labo A. Binet 46, rue Saint Jacques 75005 Paris France [email protected] ABSTRACT Although human reasoning is often biased by intuitive heuristics, recent studies on conflict detection during thinking suggest that adult reasoners detect the biased nature of their judgments. Despite their illogical response, adults seem to demonstrate a remarkable sensitivity to possible conflict between their heuristic judgment and logical or probabilistic norms. In this chapter I review the core findings and try to clarify why it makes sense to conceive this logical sensitivity as an intuitive gut feeling. CONFLICT, AROUSAL, AND LOGICAL GUT FEELINGS Imagine you’re on a game show. The host shows you two metal boxes that are both filled with $100 and $1 dollar bills. You get to draw one note out of one of the boxes. Whatever note you draw is yours to keep. The host tells you that box A contains a total of 10 bills, one of which is a $100 note. He also informs you that Box B contains 1000 bills and 99 of these are $100 notes. So box A has got one $100 bill in it while there are 99 of them hiding in box B. Which one of the boxes should you draw from to maximize your chances of winning $100? When presented with this problem a lot of people seem to have a strong intuitive preference for Box B. -
Panic Disorder Issue Brief
Panic Disorder OCTOBER | 2018 Introduction Briefings such as this one are prepared in response to petitions to add new conditions to the list of qualifying conditions for the Minnesota medical cannabis program. The intention of these briefings is to present to the Commissioner of Health, to members of the Medical Cannabis Review Panel, and to interested members of the public scientific studies of cannabis products as therapy for the petitioned condition. Brief information on the condition and its current treatment is provided to help give context to the studies. The primary focus is on clinical trials and observational studies, but for many conditions there are few of these. A selection of articles on pre-clinical studies (typically laboratory and animal model studies) will be included, especially if there are few clinical trials or observational studies. Though interpretation of surveys is usually difficult because it is unclear whether responders represent the population of interest and because of unknown validity of responses, when published in peer-reviewed journals surveys will be included for completeness. When found, published recommendations or opinions of national organizations medical organizations will be included. Searches for published clinical trials and observational studies are performed using the National Library of Medicine’s MEDLINE database using key words appropriate for the petitioned condition. Articles that appeared to be results of clinical trials, observational studies, or review articles of such studies, were accessed for examination. References in the articles were studied to identify additional articles that were not found on the initial search. This continued in an iterative fashion until no additional relevant articles were found. -
The Implications of Hypersomnia in the Context of Major Depression: Results from a Large, International, Observational Study
ARTICLE IN PRESS JID: NEUPSY [m6+; March 2, 2019;10:45 ] European Neuropsychopharmacology (2019) 000, 1–11 www.elsevier.com/locate/euroneuro The implications of hypersomnia in the context of major depression: Results from a large, international, observational study a a, b c a A. Murru , G. Guiso , M. Barbuti , G. Anmella , a, d ,e a ,f , g g h N. Verdolini , L. Samalin , J.M. Azorin , J. Jules Angst , i j k a, l C.L. Bowden , S. Mosolov , A.H. Young , D. Popovic , m c a, ∗ a M. Valdes , G. Perugi , E. Vieta , I. Pacchiarotti , For the BRIDGE-II-Mix Study Group a Barcelona Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain b Clinica Psichiatrica, Dipartimento di Igiene e Sanità, Università di Cagliari, Italy c Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Edificio Ellisse, 8 Piano, Sant’Andrea delle Fratte, 06132, Perugia, Italy d FIDMAG Germanes Hospitalàries Research Foundation, Sant Boi de Llobregat, Barcelona, Catalonia, Spain e Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy f CHU Clermont-Ferrand, Department of Psychiatry, University of Auvergne, Clermont-Ferrand, France g Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France h Department of Psychiatry, Psychotherapy and Psychosomatics, -
Neuroticism, BIS, and Reactivity to Discrete Negative Mood Inductions ⇑ Jennifer Thake, John M
Personality and Individual Differences 54 (2013) 208–213 Contents lists available at SciVerse ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid Neuroticism, BIS, and reactivity to discrete negative mood inductions ⇑ Jennifer Thake, John M. Zelenski Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, Canada K1S 5B6 article info abstract Article history: Research has established relationships between the personality dimensions of neuroticism and BIS and Received 5 March 2012 broad negative emotional reactivity. However, few researchers have examined the relationships among Received in revised form 4 August 2012 neuroticism, BIS, and discrete negative emotional reactivities. The present study examined whether indi- Accepted 27 August 2012 viduals scoring high on neuroticism and BIS were more reactive across four discrete negative mood Available online 25 September 2012 inductions, relative to those scoring low on these traits. Participants (n = 166) completed personality questionnaires, measures of current mood, viewed a specific mood-inducing film clip (sadness, anger, Keywords: fear or disgust) and then reported their moods a second time. Results revealed that neuroticism/BIS Neuroticism was associated with high reactivity to the fear and sadness inductions. Neuroticism/BIS did not predict Behavioral inhibition system Mood anger or disgust reactivity, but neuroticism/BIS and extraversion/BAS interacted in predicting anger. Emotion Although further research is -
Psychoeducation of Bipolar Disorder Patients and Their Relatives Arch Depress Anxiety 4(1): 001-002
Medical Group Archives of Depression and Anxiety DOI http://doi.org/10.17352/2455-5460.000026 ISSN: 2455-5460 CC By Michel Bourin* Short Communication Michel Bourin, Neurobiology of anxiety and mood disorders, University of Nantes, 98, rue Joseph Blanchart, 44100 Nantes, France Psychoeducation of bipolar disorder Received: 08 January, 2018 Accepted: 08 January, 2018 patients and their relatives Published: 17 January, 2018 *Corresponding author: Michel Bourin, Neurobiology of anxiety and mood disorders University of Nantes, psychosocial consequences because the patient who does 98, rue Joseph Blanchart 44100 Nantes France, Tel: not know his illness does not know his life, feels unable to +33 610858103; E-mail: [email protected]; future, to predict, feels like one of our patients would say [email protected] absolutely defenseless against the random whims of his mood. https://www.peertechz.com Misunderstanding is an opportunistic disease that aggravates the course of psychiatric disorders [2]. Short Communication Therapeutic education in practice: Regarding the treatment of bipolar disorder, therapy with psychoeducation is based Until recently, there was the belief that people with on a program that varies between 8 and 21 sessions, led by bipolar disorder were not fi t to be treated with psychological therapists (usually a psychiatrist and a psychologist). The therapies, which has been widely denied in recent years. groups may consist of patients in euthymic phase (out of crisis While it is true that the effects of therapy are not immediate, period), close relatives or mixed groups. psychoeducation also demonstrates its long-term benefi ts in people with bipolar disorder who have attended these therapies The therapists animate and organize the exchanges but it on an ongoing basis. -
Bipolar Disorder - Your Guide
yourhealthinmind.org Bipolar disorder - your guide This guide provides information and advice about bipolar disorder in adults. Table of contents It has been produced by psychiatrists – medical About bipolar disorder 2 doctors who are experts in mental health – with input from consumers and carers. It is based on up-to-date Treatment of bipolar disorder 5 scientific evidence. Who can help with bipolar disorder? 8 This guide is for: Self-care for bipolar disorder 10 • people who have bipolar disorder Helping someone with bipolar disorder 12 • people who think they might have bipolar disorder • their family and friends. Key facts • Bipolar disorder is a mental illness that • Treatments for bipolar disorder include affects a person’s mood and energy levels. medications for mania, hypomania and depression, medications to prevent • People with bipolar disorder have unusual the return of symptoms, psychological ups and downs in mood and energy, which treatments (talking therapy), and sometimes can be extreme. electroconvulsive therapy (ECT). • A diagnosis of bipolar disorder is usually • People with bipolar disorder can stay well made by a psychiatrist. Some GPs (family for longer by learning to avoid and cope doctors) and clinical psychologists can also with stress, looking after their general diagnose bipolar disorder. health, and understanding their • Bipolar disorder is a lifelong condition, but warning signs. the symptoms can be well controlled. Most • For family members and friends of someone people with bipolar disorder live full, with bipolar disorder, it can be helpful to normal lives. learn about the condition, know what to do • The right treatment for bipolar disorder can when the person has symptoms, know how control symptoms, help people get back in to get help, and get support for themselves. -
Dysphoria As a Complex Emotional State and Its Role in Psychopathology
Dysphoria as a complex emotional state and its role in psychopathology Vladan Starcevic A/Professor, University of Sydney Faculty of Medicine and Health Sydney, Australia Objectives • Review conceptualisations of dysphoria • Present dysphoria as a transdiagnostic complex emotional state and assessment of dysphoria based on this conceptualisation What is dysphoria? • The term is derived from Greek (δύσφορος) and denotes distress that is hard to bear Dysphoria: associated with externalisation? • “Mixed affect” leading to an “affect of suspicion”1,2 1 Sandberg: Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtl Medizin 1896; 52:619-654 2 Specht G: Über den pathologischen Affekt in der chronischen Paranoia. Festschrift der Erlanger Universität, 1901 • A syndrome that always includes irritability and at least two of the following: internal tension, suspiciousness, hostility and aggressive or destructive behaviour3 3 Dayer et al: Bipolar Disord 2000; 2: 316-324 Dysphoria: associated with internalisation? • Six “dysphoric symptoms”: depressed mood, anhedonia, guilt, suicide, fatigue and anxiety1 1 Cassidy et al: Psychol Med 2000; 30:403-411 Dysphoria: a nonspecific state? • Dysphoria is a “nonspecific syndrome” and has “no particular place in a categorical diagnostic system”1; it is neglected and treated like an “orphan”1 1 Musalek et al: Psychopathol 2000; 33:209-214 • Dysphoria “can refer to many ways of feeling bad”2 2 Swann: Bipolar Disord 2000; 2:325-327 Textbook definitions: dysphoria nonspecific, mainly internalising? • “Feeling -
Major Depressive Episode
Molina Healthcare Coding Education Major Depressive Episode Documentation Examples: Initial Diagnosis: 65 year old Latina presenting with new onset depressive symptoms for past 2 months including daily depressed mood, loss of energy and inability to concentrate. PHQ9 score of 12 (moderate depression). Assessment: Patent is newly diagnosed with major depression, single episode, moderate; needing medical and cognitive therapy Accurately diagnosing Major Depression requires distinguishing between a single depressive episode Plan: Start Citalopram 20 mg and refer for psychotherapy and recurrent depression. Hence, it is necessary to ICD-10 Code: F32.1 Major Depressive Disorder, single episode, moderate identify and document the manifestations of the disease burden. Another key consideration is noting OR the term “chronic” can apply to both recurrent and Initial Diagnosis: single depressive episodes. A single or first time event should be coded as F32.0-F32.9 (severity 73 year old female with many known episodes of Major specification required) and any patient who has Depression now complaining of worsening symptoms experienced subsequent episodes should be coded as including increased loss of interest in activities, hypersomnia, increased tearfulness and sadness. Denies F33.9. thoughts of self-harm ICD-10: F32.0-F32.5 Major Depressive Disorder, Assessment: Patient diagnosed with Major Depression, recurrent, single episode, specifier required (e.g., mild; unspecified; currently symptoms not controlled moderate; severe with or without psychotic Plan: Increase SSRI dosage and close follow- up recommended symptoms; in partial or full remission) ICD-10 Code: F33.9, Major Depressive Disorder, OR recurrent, unspecified ICD-10: F33.9 Major Depressive Disorder, recurrent, unspecified The Patient Health Questionnaire-9 (PHQ-9) is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. -
Reward and Emotion: an Affective Neuroscience Approach
Reward and emotion: An affective neuroscience approach David Sander1 & Lauri Nummenmaa2 1Swiss Center for Affective Sciences (CISA), Campus Biotech, and Laboratory for the Study of Emotion Elicitation and Expression, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland 2TurKu PET Centre, TurKu University Hospital, and Department of Psychology, University of TurKu, Finland Address Correspondence to: Lauri Nummenmaa Turku PET Centre c/o Turku University Hospital FI-20520 Turku, Finland Email: [email protected] Tel: +358 50 574 7933 Acknowlegements This study was supported by the Academy oF Finland (grants #294897 and #332225), Sigrid Juselius stiftelse and Signe och Anet Gyllenberg’s stiftelse, and by the Swiss National Science Foundation (grant 100019_188966). DS and LN thank Brian Knutson For in-depth discussions concerning several aspects of this paper. Conflicts of interest None Abstract Pleasure and reward are central for motivation, learning, feeling and allostasis. Although reward is without any doubt an affective phenomenon, there is no consensus concerning its relationship with emotion. In this mini-review we discuss this conceptual issue both from the perspective of theories of reward and emotion as well as human systems neuroimaging. We first describe how the reward process can be understood and dissected as intertwined with the emotion process, in particular in light of the appraisal theories, and then discuss how different facets of the reward process can be studied using neuroimaging and neurostimulation techniques. We conclude that future worK needs to focus on mapping the similarities and differences across stimuli and mechanisms that are involved in reward processing and in emotional processing, and propose that an integrative affective sciences approach would provide means for studying the emotional nature of reward. -
Early Identification of Psychosis a Primer
Early Identification of Psychosis A Primer Mental Health Evaluation & Community Consultation Unit TABLE OF CONTENTS Introduction...............................................................................................................3 Psychosis and Early Intervention........................................................................4 Why is Early Intervention Needed?...................................................................5 Risk and Onset..........................................................................................................6 Course of First-Episode Psychosis 1. Prodrome........................................................................................................7 2. Acute Phase....................................................................................................8 3. Recovery Phase..............................................................................................9 Summary of First-Episode Psychosis...............................................................11 Tips for Helpers......................................................................................................12 More Resources......................................................................................................15 Acknowledgements...............................................................................................16 2 INTRODUCTION Psychosis is a condition characterized by loss of contact with reality and may involve severe disturbances in perception, cognition, behavior, -
Depression Treatment Guide DSM V Criteria for Major Depressive Disorders
MindsMatter Ohio Psychotropic Medication Quality Improvement Collaborative Depression Treatment Guide DSM V Criteria for Major Depressive Disorders A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1) Depressed mood most of the day, nearly every day, as 5) Psychomotor agitation or retardation nearly every day indicated by either subjec tive report (e.g., feels sad, empty, (observable by others, not merely subjective feelings of hopeless) or observation made by others (e.g., appears restlessness or being slowed down). tearful). (Note: In children and adolescents, can be irritable 6) Fatigue or loss of energy nearly every day. mood.) 7) Feelings of worthlessness or excessive or inappropriate 2) Markedly diminished interest or pleasure in all, or almost all, guilt (which may be delu sional) nearly every day (not activities most of the day, nearly every day (as indicated by merely self-reproach or guilt about being sick). either subjective account or observation). 8) Diminished ability to think or concentrate, or 3) Significant weight loss when not dieting or weight gain indecisiveness, nearly every day (ei ther by subjective (e.g., a change of more than 5% of body weight in a account or as observed by others). month}, or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected 9) Recurrent thoughts of death (not just fear of dying), weight gain.) recurrent suicidal ideation with out a specific plan, or a suicide attempt or a specific plan for committing suicide.