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28.01.2015

Bipolar disorder depressive type, tinnitus treatment johns hopkins - For Begninners

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The prevalence of BPD is the same in males and females, although male patients have more manic episodes and female patients have more depressive episodes.
In addition to the adverse psychosocial, vocational, and societal impacts of BPD, the lifetime suicide rate associated with BPD (15.6%) is higher than corresponding rates in any other psychiatric disorder. The diagnostic criteria for a major depressive episode can be found in the chapter on depression.
The criteria are met both for a manic episode (Box 1) and for a major depressive episode (see Box 3 in the chapter on depression) (except for duration) nearly every day for at least 1 week. BPD is subdivided into types I and II to reflect the type of manic episodes the patient reports.
Criteria, except for duration, are currently (or most recently) met for a manic, a hypomanic, a mixed, or a major depressive episode. The mood symptoms in the first two criteria are not better accounted for as schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev.
If an active mood episode is identified, rule out mood disorder due to a general medical condition or one that is substance-related. If psychosis accompanies a mood episode, rule out schizophrenia, schizoaffective disorder, delusional disorder, or psychosis due to a general medical condition.
BPD is an important consideration in the differential diagnosis of a major depressive episode.
Mania is generally more easily managed than depression, although it requires hospitalization more often. Mixed depressive and manic episodes present a difficult treatment challenge best met by first stabilizing manic behavior and then addressing depression. OFC is the only FDA-approved treatment for acute bipolar depression and delivers both antidepressant and antipsychotic medications simultaneously in one preparation. Neither is currently FDA approved for this indication, and the strength of the data supporting their use for bipolar depression is modest at best. Electroconvulsive therapy can effectively be used to treat either manic or depressive episodes, although it is generally reserved for medication-refractory cases. Maintaining a strong working alliance with the bipolar patient typically requires additional time, effort, and skill.


Treatment strategies must be individualized and adjusted at different phases of the mood disorder. Olanzapine-fluoxetine combination (OFC) and mood stabilizers are first-line treatments for bipolar depression. Ryan MM, Lockstone HE, Huffaker SJ, et al: Gene expression analysis of bipolar disorder reveals downregulation of the ubiquitin cycle and alterations in synaptic genes. Valtonen HM, Suominen K, Mantere O, et al: Suicidal behaviour during different phases of bipolar disorder. Calabrese JR, Keck PE Jr, Macfadden W, et al: A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Ghaemi SN, Miller CJ, Berv DA, et al: Sensitivity and specificity of a new bipolar spectrum diagnostic scale.
Described as periods in which symptoms of hypomania or depression are present but do not constitute a major manic or depressive episode.
The first lifetime manifestation of BPD is typically a major depressive episode (MDE), with onset during late adolescence or early adulthood.
A higher rate of mood and anxiety disorders exists in the first-degree relatives of persons with BPD than in the general population.
In addition to episodes of either full-blown mania or major depression, patients can have episodes of subsyndromal depression, hypomania, or mixed states characterized by simultaneous occurrence of both depressive and manic features. A diagnosis of bipolar I disorder is given if there has been at least one lifetime episode of mania or a true mixed episode; a diagnosis of bipolar II disorder depends on at least one lifetime episode of hypomania, with none of the episodes achieving criteria for mania. An atypical antipsychotic or a mood stabilizer is typically administered to stabilize the manic behavior, and depression is addressed with standard antidepressant treatment. Antidepressants, when prescribed alone, are not effective for bipolar depression and are not formally indicated for such use by the FDA. Investigation of quetiapine (Seroquel) as monotherapy for bipolar depression has produced promising results and might receive FDA approval in the near future.
Their off-label use is nevertheless recommended, given the paucity of effective treatments for bipolar depression.
Once this mood disorder has declared itself, the patient should be counseled regarding the chronic risk for relapse and recurrence; lifetime treatment is recommended. The Bipolar Spectrum Diagnostic Scale (BSDS) involves an easy-to-read, one-page story that depicts typical mood swing experiences.


In contrast, the postpartum period is associated with increased risk for bipolar relapse and illness onset.
Most often a person with bipolar disorder experiences moods that shift from highs (mania) to lows (depression) in varying degrees and severity.
With a Bipolar II diagnosis, depressive episodes are more frequent and more intense than hypomanic episodes. A differentiating characteristic of this type of Bipolar is that symptoms are never absent for more than two months.
Traditionally, classic BPD has been depicted as mood episodes alternating from mania to depression and back, but the variable course depicted in Figure 3 is more common.
This may have led to an overdiagnosis of BPD, which until recently was underdetected or misdiagnosed as recurrent major depressive disorder (MDD). People with Bipolar II often experience a state of hypomania, instead of full blown manic episodes that are characterized by Bipolar type 1.
People with Bipolar type 2 do not experience full blown manic episodes like people with Bipolar type 1 do, however they instead experience episodes of hypomania, that can be described as periods of high energy and impulsiveness or irritability and aggression. The natural course of bipolar disorder is for episode frequency to gradually increase and for an ever-increasing percentage of episodes to be characterized by depression.
This is an error that is easily committed even by experienced clinicians, because MDEs and dysthymia constitute the predominant mood disturbance in BPD, especially BPD type II. Because these potential adverse outcomes are not unique to olanzapine and are regarded as an effect of the atypical antipsychotic class, OFC should be considered as a first-line treatment for bipolar depression. However, they don’t have full-blown manic episodes, major depressive episodes, or mixed episodes (which combine features of both depression and mania).
In general, late-onset mania suggests drug toxicity or an underlying medical disorder until proved otherwise.



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