Bipolar Disorder
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Treatment, Adherence, and Disability in Bipolar Disorder
Petri Arvilommi Treatment, Adherence, and Disability in Bipolar Disorder ACADEMIC DISSERTATION To be presented with the permission of the Faculty of Medicine, University of Helsinki, for public examination at the HUCH Psychiatry Centre, Christian Sibelius Auditorium, Välskärinkatu 12, on 10th June 2016, at 12 noon. Department of Psychiatry University of Helsinki Helsinki, Finland Helsinki 2016 Supervisors Professor Erkki Isometsä, M.D., Ph.D. Department of Psychiatry, Faculty of Medicine University of Helsinki Helsinki, Finland and Docent Kirsi Suominen, M.D., Ph.D. Department of Mental Health and Substance Abuse, City of Helsinki, Social Services and Health Care Helsinki, Finland Reviewers Professor Jyrki Korkeila, M.D., Ph.D. Faculty of Medicine, University of Turku, Turku, Finland and Associate professor Olli Kampman, M.D., Ph.D. School of Medicine, University of Tampere Seinäjoki Hospital District, Department of Psychiatry Tampere, Finland Opponent Professor Esa Leinonen, M.D., Ph.D. School of Medicine, University of Tampere Dissertationes Scholae Doctoralis Ad Sanitatem Investigandam Universitatis Helsinkiensis ISBN 978-951-51-2205-6 (pbk.) ISBN 978-951-51-2206-3 (PDF) ISSN 2342-3161 (print) ISSN 2342-317X (online) http://ethesis.helsinki.fi T a m p e r e , F i n l a n d “The endless questioning finally ended. My psychiatrist looked at me, there was no uncertainty in his voice. “Manic-depressive illness.” I admired his bluntness. I wished him locusts on his lands and a pox upon his house. Silent, unbelievable rage. I smiled pleasantly. He smiled back. The war had just begun.” Kay Redfield Jamison “An Unquiet Mind” (1995) Abstract Petri Arvilommi. -
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. -
Bipolar Disorder
Bipolar Disorder D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S P U B L I C H E A L T H S E R V I C E N A T I O N A L I N S T I T U T E S O F H E A L T H National Institute of Mental Health ipolar disorder, also known as manic- depressive illness, is a brain disorder that causes unusual shifts in a person�s mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives. More than 2 million American adults,1 or about 1 percent of the population age 18 and older in any given year,2 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person�s life. -
Types of Bipolar Disorder Toms Are Evident
MOOD DISORDERS ASSOCIATION OF BRITISH COLUmbIA T Y P E S O F b i p o l a r d i s o r d e r Bipolar disorder is a class of mood disorders that is marked by dramatic changes in mood, energy and behaviour. The key characteristic is that people with bipolar disorder alternate be- tween episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months. The mood distur- bances are severe enough to cause marked impairment in the person’s func- tioning. The experience of mania is not pleasant and can be very frightening to The Diagnotistic Statisti- the person. It can lead to impulsive behaviour that has serious consequences cal Manual (DSM- IV-TR) is a for the person and their family. A depressive episode makes it difficult or -im manual used by doctors to possible for a person to function in their daily life. determine the specific type of bipolar disorder. People with bipolar disorder vary in how often they experience an episode of either mania or depression. Mood changes with bipolar disorder typically occur gradually. For some individuals there may be periods of wellness between the different mood episodes. Some people may also experience multiple episodes within a 12 month period, a week, or even a single day (referred to as “rapid cycling”). The severity of the mood can also range from mild to severe. Establishing the particular type of bipolar disorder can greatly aid in determin- ing the best type of treatment to manage the symptoms. -
‗DEFINED NOT by TIME, but by MOOD': FIRST-PERSON NARRATIVES of BIPOLAR DISORDER by CHRISTINE ANDREA MUERI Submitted in Parti
‗DEFINED NOT BY TIME, BUT BY MOOD‘: FIRST-PERSON NARRATIVES OF BIPOLAR DISORDER by CHRISTINE ANDREA MUERI Submitted in partial fulfillment of the requirements For the degree of Doctor of Philosophy Dissertation Adviser: Dr. Kimberly Emmons Department of English CASE WESTERN RESERVE UNIVERSITY August 2011 2 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Christine Andrea Mueri candidate for the Doctor of Philosophy degree *. (signed) Kimberly K. Emmons (chair of the committee) Kurt Koenigsberger Todd Oakley Jonathan Sadowsky May 20, 2011 *We also certify that written approval has been obtained for any proprietary material contained therein. 3 I dedicate this dissertation to Isabelle, Genevieve, and Little Man for their encouragement, unconditional love, and constant companionship, without which none of this would have been achieved. To Angie, Levi, and my parents: some small piece of this belongs to you as well. 4 Table of Contents Dedication 3 List of tables 5 List of figures 6 Acknowledgements 7 Abstract 8 Chapter 1: Introduction 9 Chapter 2: The Bipolar Story 28 Chapter 3: The Lay of the Bipolar Land 64 Chapter 4: Containing the Chaos 103 Chapter 5: Incorporating Order 136 Chapter 6: Conclusion 173 Appendix 1 191 Works Cited 194 5 List of Tables 1. Diagnostic Criteria for Manic and Depressive Episodes 28 2. Therapeutic Approaches for Treating Bipolar Disorder 30 3. List of chapters from table of contents 134 6 List of Figures 1. Bipolar narratives published by year, 2000-2010 20 2. Graph from Gene Leboy, Bipolar Expeditions 132 7 Acknowledgements I gratefully acknowledge my advisor, Kimberly Emmons, for her ongoing guidance and infinite patience. -
Specificity of Psychosis, Mania and Major Depression in A
Molecular Psychiatry (2014) 19, 209–213 & 2014 Macmillan Publishers Limited All rights reserved 1359-4184/14 www.nature.com/mp ORIGINAL ARTICLE Specificity of psychosis, mania and major depression in a contemporary family study CL Vandeleur1, KR Merikangas2, M-PF Strippoli1, E Castelao1 and M Preisig1 There has been increasing attention to the subgroups of mood disorders and their boundaries with other mental disorders, particularly psychoses. The goals of the present paper were (1) to assess the familial aggregation and co-aggregation patterns of the full spectrum of mood disorders (that is, bipolar, schizoaffective (SAF), major depression) based on contemporary diagnostic criteria; and (2) to evaluate the familial specificity of the major subgroups of mood disorders, including psychotic, manic and major depressive episodes (MDEs). The sample included 293 patients with a lifetime diagnosis of SAF disorder, bipolar disorder and major depressive disorder (MDD), 110 orthopedic controls, and 1734 adult first-degree relatives. The diagnostic assignment was based on all available information, including direct diagnostic interviews, family history reports and medical records. Our findings revealed specificity of the familial aggregation of psychosis (odds ratio (OR) ¼ 2.9, confidence interval (CI): 1.1–7.7), mania (OR ¼ 6.4, CI: 2.2–18.7) and MDEs (OR ¼ 2.0, CI: 1.5–2.7) but not hypomania (OR ¼ 1.3, CI: 0.5–3.6). There was no evidence for cross-transmission of mania and MDEs (OR ¼ .7, CI:.5–1.1), psychosis and mania (OR ¼ 1.0, CI:.4–2.7) or psychosis and MDEs (OR ¼ 1.0, CI:.7–1.4). -
Guidance on the Use of Mood Stabilizers for the Treatment of Bipolar Affective Disorder Version 2
Guidance on the use of mood stabilizers for the treatment of bipolar affective disorder Version 2 RATIFYING COMMITTEE DRUGS AND THERAPEUTICS GROUP DATE RATIFIED July 2015 REPLACES Version 1 dated July 2013 NEXT REVIEW DATE July 2017 POLICY AUTHORS Jules Haste, Lead Pharmacist, Brighton and Hove Members of the Pharmacy Team (contributors are listed overleaf) If you require this document in an alternative format, i.e. easy read, large text, audio or Braille please contact the pharmacy team on 01243 623349 Page 1 of 49 Contributors Jed Hewitt, Chief Pharmacist - Governance & Professional Practice James Atkinson, Pharmacist Team Leader Mental Health and Community Services Miguel Gomez, Lead Pharmacist, Worthing. Hilary Garforth, Lead Pharmacist, Chichester. Pauline Daw, Lead Pharmacist (CRHTs & AOT), East Sussex. Iftekhar Khan, Lead Pharmacist (S&F Service), East Sussex. Graham Brown, Lead Pharmacist CAMHS & EIS. Gus Fernandez, Specialist Pharmacist MI and MH Lisa Stanton, Specialist Pharmacist Early Intervention Services & Learning Disabilities. Nana Tomova, Specialist Pharmacist, Crawley. Page 2 of 49 Section Title Page Number Introduction and Key Points 4 1. General principles in the treatment of acute mania 6 2. General principles in the treatment of bipolar depression 8 3. General principles in long term treatment 10 4. Rapid cycling 13 5. Physical health 13 6. Treatment in special situations 6.1 Pregnancy 15 6.2 Breast-feeding 17 6.3 Older adults 19 6.4 Children and adolescents 22 6.5 Learning disabilities 29 6.6 Cardiac dysfunction 30 6.7 Renal dysfunction 34 6.8 Hepatic dysfunction 37 6.9 Epilepsy 41 7. The risk of switching to mania with antidepressants 43 8. -
What Is Bipolar Disorder?
Bipolar Disorder Fact Sheet For more information about bipolar or other mental health disorders, call 513-563-HOPE or visit our website at www.lindnercenterofhope.com. What Is Bipolar Disorder? What does your mood Each year, nearly 6 million adults (or approximately 5% of the population) in the U.S. are affected by bipolar disorder, according to the Depression and Bipolar Support say about you? Alliance. While the condition is treatable, unfortunately bipolar disorder is frequently misdiagnosed and may be present an average of 10 years before it is correctly identified. Go to My Mood Monitor™, a three minute assessment Bipolar disorder (also known as bipolar depression or manic depression) is identified for anxiety, depression, PTSD by extreme shifts in mood, energy, and functioning that can be subtle or dramatic. The characteristics can vary greatly among individuals and even throughout the and bipolar disorder, at course of one individual’s life. www.mymoodmonitor.com to see if you may need a Bipolar disorder is usually a life-long condition that begins in adolescence or early professional evaluation. adulthood with recurring episodes of mania (highs) and depression (lows) that can continue for days, months or even years. My Mood Monitor™ Copyright © 2002-2010 by M3 Information™ Phases of Bipolar Disorder • Mania is the activated phase of bipolar disorder and is characterized by extreme moods, increased or impulsive mental and physical activities, and risk taking. • Hypomania describes a mild-to-moderate level of mania. Because it may feel good to the individual experiencing it, this condition can be difficult for someone with bipolar illness to recognize as a concern. -
Kay Redfield Jamison
The Rhoda and Bernard Sarnat International Prize in Mental Health 2015 Honoree Kay Redfield Jamison, PhD Dalio Family Professor in Mood Disorders and Professor of Psychiatry, Johns Hopkins University School of Medicine Co-Director, Johns Hopkins Mood Disorders Center The 2015 Rhoda and Bernard Sarnat International Prize in Mental Health is awarded to Kay Jamison for her profound insights into affective disorders and suicide that have not only advanced the field, but also transformed public understanding. Her work combines cutting-edge research with deeply humanistic and often personal narratives—an approach that has cut through stigma to become a cornerstone of the field and a beacon for sufferers of mood disorders. Dr. Jamison is the co-author of Manic-Depressive Illness, the standard medical textbook in the field, and has written more than 125 scientific and clinical articles about mood disorders, suicide, creativity, and lithium. However, her greatest impact may lie in her works of narrative nonfiction, which probe links between creativity and mental illness, trace the natural history of affective disorders, and explore the suicidal mind. An Unquiet Mind: A Memoir of Moods and Madness, which chronicles Dr. Jamison’s own experience with manic-depressive illness, marked a major milestone in combating stigma in the psychiatric profession. It remained on the New York Times best-seller list for 5 months and has been translated into 25 languages. Johns Hopkins Hospital, where Dr. Jamison co-directs the Mood Disorders Center, praises the book on its website as a kind of “bibliotherapy” that does “what pills can’t: It lets patients read for themselves how destructive not taking their medicine can be, it tells of the healing power of structure, psychotherapy and a social network. -
A Nation of Maniacs: Understanding Commodified Mania Through Bipolar Narratives Alexandra Marino
orienting / 1 A Nation of Maniacs: Understanding Commodified Mania Through Bipolar Narratives Alexandra Marino Excerpt “How could one, should one, recapture that intensity…the glorious moods of dancing all night and into the morning, the gliding through starfields and dancing along the rings of Saturn, the zany manic enthusiasms? How can one ever bring back the long summer days of passion, the remembrance of lilacs, ecstasy, and gin fizzes that spilled down over a garden wall, and the peals of riotous laughter that lasted until the sun came up or the police arrived?” — Jamison, 211 This quote epitomizes the conflicted feelings Dr. Kay Redfield Jamison has towards her exhilarating and transcendental manic episodes. In her autobiography An Unquiet Mind: A Memoir of Moods and Madness, Jamison chronicles her battle with the cyclical highs and lows of bipolar disorder, a disease that for her is simultaneously lethal and life-affirming. Her manic highs are characterized by hypersexuality, fluidity of ideas, exuberance, extreme confidence, and hyperactivity (128). In contrast, when she cycles into depression after a manic episode, a desolate fog encapsulates her mind, bringing thoughts of suicide (39). Even as a professor of psychiatry who understands firsthand the ramifications of depression, she battles against taking the very same medications she urges her own patients to take. She fears that these mood stabilizers would eradicate the sweeping majesty of her mania, as depicted above (92). After years of resisting consistent treatment, she finally decides to stay on her medication, realizing that a life with less dramatic fluctuations in moods is preferable over no life at all. -
Which Is It: ADHD, Bipolar Disorder, Or PTSD?
HEALINGHEALINGA PUBLICATION OF THE HCH CLINICIANS’ HANDSHANDS NETWORK Vol. 10, No. 3 I August 2006 Which Is It: ADHD, Bipolar Disorder, or PTSD? Across the spectrum of mental health care, Anxiety Disorders, Attention Deficit Hyperactivity Disorders, and Mood Disorders often appear to overlap, as well as co-occur with substance abuse. Learning to differentiate between ADHD, bipolar disorder, and PTSD is crucial for HCH clinicians as they move toward integrated primary and behavioral health care models to serve homeless clients. The primary focus of this issue is differential diagnosis. Readers interested in more detailed clinical information about etiology, treatment, and other interventions are referred to a number of helpful resources listed on page 6. HOMELESS PEOPLE & BEHAVIORAL HEALTH Close to a symptoms exhibited by clients with ADHD, bipolar disorder, or quarter of the estimated 200,000 people who experience long-term, PTSD that make definitive diagnosis formidable. The second chronic homelessness each year in the U.S. suffer from serious mental causative issue is how clients’ illnesses affect their homelessness. illness and as many as 40 percent have substance use disorders, often Understanding that clinical and research scientists and social workers with other co-occurring health problems. Although the majority of continually try to tease out the impact of living circumstances and people experiencing homelessness are able to access resources comorbidities, we recognize the importance of causal issues but set through their extended family and community allowing them to them aside to concentrate primarily on how to achieve accurate rebound more quickly, those who are chronically homeless have few diagnoses in a challenging care environment. -
Generalized Anxiety Disorder: Practical Assessment and Management MICHAEL G
Generalized Anxiety Disorder: Practical Assessment and Management MICHAEL G. KAVAN, PhD; GARY N. ELSASSER, PharmD; and EUGENE J. BARONE, MD Creighton University School of Medicine, Omaha, Nebraska Generalized anxiety disorder is common among patients in primary care. Affected patients experience excessive chronic anxiety and worry about events and activities, such as their health, family, work, and finances. The anxiety and worry are difficult to control and often lead to physiologic symptoms, including fatigue, muscle tension, restless- ness, and other somatic complaints. Other psychiatric problems (e.g., depression) and nonpsychiatric factors (e.g., endocrine disorders, medication adverse effects, withdrawal) must be considered in patients with possible generalized anxiety disorder. Cognitive behavior therapy and the first-line pharmacologic agents, selective serotonin reuptake inhibitors, are effective treatments. However, evidence suggests that the effects of cognitive behavior therapy may be more durable. Although complementary and alternative medicine therapies have been used, their effectiveness has not been proven in generalized anxiety disorder. Selection of the most appropriate treatment should be based on patient preference, treatment success history, and other factors that could affect adherence and subsequent effective- ness. (Am Fam Physician. 2009;79(9):785-791. Copyright © 2009 American Academy of Family Physicians.) ▲ Patient information: nxiety disorders, such as generalized GAD is 3.1 percent in population-based sur-