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11.01.2015

Bipolar ii disorder and suicidal behavior, how to stop ear ringing from shooting - Within Minutes

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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. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting throughout at least 1 week (or any duration if hospitalization is necessary). The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. 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. 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. 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.
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.
The literature regarding medication treatment for children and adolescents with BPD is limited, and many of the current recommendations are based on studies of adults. 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. The library is an integral part of a project being developed by FAPESP - Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, in partnership with BIREME - the Latin American and Caribbean Center on Health Sciences Information. The Project envisages the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific literature in electronic format. The interface also provides access to the full text of articles via author index or subject index, or by a search form on article elements such as author names, words from title, subject, words from the full text and publication year.
The disturbance of mood in BPD is episodic and recurrent, cycling at varying intervals from one mood state to another. A higher rate of mood and anxiety disorders exists in the first-degree relatives of persons with BPD than in the general population. Neuroimaging studies point to involvement of cortical, limbic, basal ganglia, and cerebellar structures in BPD. 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.
United States Food and Drug Administration (FDA)-approved agents for treating BPD are listed in Table 1.
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. The first episode of mania or hypomania might not occur until several years later, and until that time a diagnosis of BPD cannot be made. 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). Occasionally, the primary care physician who is familiar with the assessment and treatment of BPD may accept full responsibility for the BPD patient's management, although this typically happens after consultation with a psychiatrist. Olanzapine, used either alone or as OFC has been associated with weight gain and hyperglycemia, and there are published case reports of diabetic ketoacidosis. 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.
In addition to mood elevation, the symptoms of mania include inflated self-esteem, decreased need for sleep, pressured and often loud speech, flight of ideas, distractibility, and increased goal-directed behavior often focused on pleasurable activities that have a high potential for becoming reckless and self destructive. 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. These include simultaneously administering an antidepressant and an antipsychotic, administering mood-stabilizing medication, or administering the combination formulation of olanzapine and fluoxetine (OFC, Symbyax).
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. Treatment of mania secondary to HIV-related illness should be directed toward symptoms and underlying causes.
In general, late-onset mania suggests drug toxicity or an underlying medical disorder until proved otherwise. Mild mania and hypomania often respond to one antimanic drug, whereas acute manic crises often require two or more agents to stabilize the mood. These have included monotherapy with the lowest effective dose of a drug for the shortest period, preconception coadministration of multivitamins with folate, and avoidance of antimanic agents during the first trimester.



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