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12.11.2014

Bipolar symptoms dsm 5, ticking in your ear - For You

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The 'face' of bipolar disorder to many is mania; however, the 'down side' is truly the depressed phase.
Differentiating major depressive disorder (MDD) from depression in bipolar disorder (BPD), particularly BPD II, can be a challenge. In conjunction with a clinical evaluation, evidence-based validated measures can be helpful to clinicians in both the initial assessment and the long-term management of bipolar depression. Data shows that combined olanzapine and fluoxetine leads to more symptomatic improvement than does olanzapine or placebo alone. Other mood stabilizers such as lithium and valproate have not demonstrated efficacy in acute treatment of bipolar depression. It is estimated that up to a one-third of patients with bipolar disorder do not respond to treatments in naturalistic studies and this is considered to be a conservative estimate.3,36 Many patients who receive adequate pharmacotherapy still may have lengthy and debilitating periods of subthreshold depressive symptoms after major episodes. These pervasive but subthreshold depressive symptoms have been associated with social and occupational impairment.37 There is little evidence to date that offers any effective strategies for patients who do not respond to first-line treatments. Interpersonal and social rhythm therapy, is an adaptation of the interpersonal psychotherapy for depression and approaches interpersonal problems through problem-solving by encouraging patients to regulate and maintain daily routines and sleep and wake rhythms.58 In a large (n=175) randomized clinical trial,58 acutely manic, mixed, or depressed patients with bipolar I disorder were assigned to weekly interpersonal and social rhythm therapy, or to equally intensive clinical management, both with pharmacotherapy.
Timely assessment of bipolar disorder in patients who present with major depressive symptoms is critical.
The DSM-IV specifier “with atypical features” can be used to characterize the current or most recent depressive episode in patients with either unipolar or bipolar type mood disorder and in patients with dysthymic disorder.10 As described in the Table, the DSM-IV specifier requires the presence of mood reactivity (criterion A) and at least 2 of 4 criterion B features (significant weight gain or hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity resulting in social or occupational impairment). Studies have suggested that patients with atypical depression tend to have an earlier onset of symptoms and a more chronic course than their melancholic counterparts.24,26,27Atypical depression is more common in younger women. The hypothesis that reactive mood as a mandatory criterion is not indispensable for the diagnosis of atypical depression was supported by the community study by Angst and colleagues.21 Although mood reactivity was the most common symptom reported by their sample of patients with atypical depression (89% to 90%), other symptoms (ie, rejection sensitivity, leaden paralysis, and hypersomnia) were also quite commonly present (78% to 89%). In DSM-5, the diagnosis of Mixed Episode has been eliminated and replaced by three "mixed features" specifiers.
The Mood Disorder Questionnaire (MDQ) was developed specifically to help clinicians differentiate unipolar depression from bipolar depression.10 It comprises 15 questions that can be easily administered in an office setting.
Kessing and colleagues studied patients with bipolar disorder (n=158) who were randomized to either a specialized mood disorder clinic that offered combined intervention with evidence-based pharmacological treatment and group psychoeducation or a standard treatment outpatient clinic and followed for 2.5 years. In a study of euthymic bipolar I and bipolar II, patients were randomly assigned to pharmacotherapy along with 21 sessions of structured group psychoeducation or 21 sessions of an unstructured support group.
For BP II, like the coin toss, the outcomes would be greater than chance (54%) of being symptomatic with a striking 93% of that time in a depressed state.
Evidence-based screening tools such as the MDQ can assist clinicians in making a diagnosis of bipolar depression. Correlates of treatment-emergent mania associated with antidepressant treatment in bipolar depression. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.


The Mood Disorder Questionnaire: A Simple, Patient-Rated Screening Instrument for Bipolar Disorder. Bipolar I, bipolar II, and nonbipolar major depression among the relatives of affectively ill probands. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis.
Continuation of quetiapine versus switching to placebo or lithium for maintenance treatment of bipolar I disorder (Trial 144: a randomized controlled study). Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Lurasidone Monotherapy For The Treatment Of Bipolar I Depression: Results of a 6-week, Double-Blind, Placebo-Controlled Study. Lurasidone adjunctive to lithium or valproate for the treatment of bipolar depression: results of a 6-week, double-blind, placebo-controlled study. Effect of lurasidone on metabolic indices in bipolar i depression: data from monotherapy and adjunctive studies. Aripiprazole monotherapy in nonpsychotic bipolar I depression: results of 2 randomized, placebo-controlled studies. Efficacy and safety of adjunctive oral ziprasidone for acute treatment of depression in patients with bipolar I disorder: a randomized, double-blind, placebo-controlled trial. Discovery and development of lamotrigine for bipolar disorder: a story of serendipity, clinical observations, risk taking, and persistence.
Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: a multicenter, double-blind, placebo-controlled trial. Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Prescribing trends in bipolar disorder: cohort study in the United Kingdom THIN primary care database 1995-2009.
Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Subsyndromal depressive symptoms are associated with functional impairment in patients with bipolar disorder: results of a large, multisite study. Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.


Evidence-based guidelines for treating bipolar disorder: revised second edition--recommendations from the British Association for Psychopharmacology. Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. The integration of measurement and management for the treatment of bipolar disorder: a STEP-BD model of collaborative care in psychiatry. Early-onset bipolar disorder and treatment delay are risk factors for poor outcome in adulthood. Common and specific elements of psychosocial treatments for bipolar disorder: a survey of clinicians participating in randomized trials.
A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses.
Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial. Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial.
Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. This could be done using the available literature or, ideally, through more specific studies (ie, compare subjects with 2 or more criterion B symptoms and reactive mood with subjects with 2 or more criterion B symptoms without reactive mood). Interestingly, other antipsychotics such has aripiprazole29* and ziprasidone30* have failed to demonstrate efficacy in bipolar depression over placebo.
Effects extended to relationship functioning and life satisfaction.51 There were no differences among the three intensive modalities in symptoms or psychosocial functioning over 1 year. Treatment of bipolar depression can be complex and requires a more sophisticated approach than major depressive disorder.
The inclusion of mood reactivity as an essential feature also neglects the fact that some depressive episodes, when quite severe, manifest with a nonreactive mood, even in the presence of reversed neurovegetative symptoms.



Levels of depression mild moderate severe
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