Bipolarity: beyond classic mania:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1999
|
| Series: | The psychiatric clinics of North America
22,3 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII S., S. 517 - 711 Ill., graph. Darst. |
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| adam_text | I BIPOLARITY: BEYOND CLASSIC MANIA
CONTENTS
Preface xi
The Evolving Bipolar Spectrum: Prototypes I, II, III, and
IV 517
Hagop S. Akiskal and Olavo Pinto
This article argues for the necessity of a partial return to Kraepe
lin s broad concept of manic depressive illness, and proposes
definitions and provides prototypical cases to illustrate the rich
clinical phenomenology of bipolar subtypes I through IV. Al¬
though considerable evidence supports such extensions of bipo
larity encroaching upon the territory of major depressive disorder,
further research is needed in this area. From a practice standpoint,
the compelling reason for broadening the bipolar spectrum lies
in the utility of mood stabilizers as augmentation or monotherapy
in the treatment of major depressive disorders with soft bipolar
features falling short of the current strict standards for the diagno¬
sis of bipolar II and hypomania in DSM IV and ICD 10.
Clinical Picture and Etiological Models of Mixed States 535
Marlene P. Freeman and Susan L. McElroy
Although conceptualized as polar opposites, manic and de¬
pressive symptoms often co occur in bipolar disorder. This article
explores the clinical characteristics, prevalence, biologic features,
and response to treatments of mixed states. Issues of diagnosis
and cause are considered. The course is often protracted beyond
acute episodes, psychotic symptoms are common, and suicide is
a major risk. Bipolar mixed states are over represented in women.
Mixed states respond poorly to lithium salts; mood stabilizers,
particularly divalproex, are the mainstay of modern treatment.
Electroconvulsive therapy is also effective, and can be used in
severe cases.
THE PSYCHIATRIC CLINICS OF NORTH AMERICA
VOLUME 22 • NUMBER 3 • SEPTEMBER 1999 vii
Agitated Depression as a Mixed State and the Problem
of Melancholia 547
Athanasios Koukopoulos and Alexa Koukopoulos
After a review of the literature on melancholia agitata and on the
concept and clinical forms of mixed states, the psychopathology
of agitated depression is discussed. Clinical forms are described,
and new diagnostic criteria are proposed. Recognizing the mixed
nature of agitated depression is crucial because many patients
who have adverse reactions to antidepressants suffer from this
syndrome. The term mixed depression is proposed for all forms of
agitated depression.
Anxious Bipolar Comorbidity: Diagnostic and Treatment
Challenges 565
Giulio Perugi, Christina Toni, and Hagop S. Akiskal
This article describes multiple anxiety comorbidity in the setting
of unstable bipolar syndromes, associated with alcohol and sub¬
stance abuse. Also described are panic attacks during mania,
social phobia followed by hypomania as well as bipolar disorder
manifesting as episodic obsessive compulsive disorder. The use of
psychotropic combinations is necessary because of the syndromic
complexity and the contrasting effects of pharmacologic treat¬
ments. The identification of differential patterns of comorbidity
may provide important information in distinguishing more ho¬
mogeneous clinical subtypes of affective disorders from the ge¬
netic, temperamental, and therapeutic point of view. The pattern
of complex relationships among these disorders requires better
designed prospective observations. This is also true for putative
temperamental (e.g. cyclothymia, interpersonal sensitivity) and
personality (e.g. histrionic and borderline) factors, which might
play a predisposing role in several clinically comorbid syn¬
dromes.
Rapid Cycling Bipolar Disorder: An Overview of
Research and Clinical Experience 585
Nael Kilzieh and Hagop S. Akiskal
Rapid cycling bipolar disorder (RCBD) has been recognized as a
refractory course pattern of the illness in up to 20% of bipolar,
especially type II, patients. Data are generally consistent in indi¬
cating that RCBD is more common in women. Familial bipolarity
does not distinguish RCBD from other bipolar patients. This
article reviews evidence of putative risk factors, such as anteced¬
ent cyclothymic temperament, borderline hypothyroidism, and
exposure to antidepressant medications; however, de novo rapid
cycling in the absence of such factors also occurs. Clinicians
are admonished to refrain from using antidepressants—with the
possible exception of bupropion—and to maintain patients on
mood stabilizer combinations of which valproate appears to be
the most useful ingredient.
viii CONTENTS
Substance Abuse and Bipolar Comorbidity 609
Susan C. Sonne and Kathleen T. Brady
Bipolar disorder and substance abuse commonly co occur. In fact,
as many as 50% of individuals with bipolar disorder have been
found to have a lifetime history of substance abuse or depen¬
dence. This article discusses the very important comorbidity of
bipolar disorder as it is complicated by substance abuse, focusing
on the prevalence, course, diagnostic considerations and treat¬
ment.
Bipolarity in Children 629
Laura Sanchez, Owen Hagino, Elizabeth Weller, and
Ronald Weller
Childhood and adolescent bipolar disorder has been less studied
than adult onset bipolar illness. Case reports of mania in child¬
hood can be found as early as the mid nineteenth century, how¬
ever. Historically, several factors have made the accurate diagno¬
sis of bipolar disorder in children difficult: (1) clinical bias against
the diagnosis of mania in children, (2) low base rate of disorder,
(3) symptom overlap between bipolar disorder and other more
prevalent childhood onset psychiatric disorders, and (4) develop¬
mental constraints and variability in clinical presentation.
The Nature and Management of Mania in Old Age 649
Kenneth I. Schulman and Nathan Herrmann
Mania in old age represents a syndrome involving affective vul¬
nerability in association with neurologic lesions that affect specific
areas of the brain. Most patients suffering from mania in late life
have converted to bipolarity later in life after many years and
often repeated episodes of depression or else have developed
mania in association with specific neurologic insults, particularly
cerebrovascular disease (vascular mania). The outcome is gener¬
ally worse in mania than in depression with higher prevalence of
cognitive dysfunction, persistent symptoms, and greater mortal¬
ity. The management of elderly bipolar patients with mood stabi¬
lizers reflects the experience with a mixed age population primar¬
ily involving the use of lithium carbonate and valproate in
appropriately adjusted dosages and serum levels, with valproate
having an edge on better tolerability. The use of neuroleptics is
often unavoidable in initial stabilization, and electroconvulsive
therapy can be life saving in severely overactive or refractory pa¬
tients.
Bipolar II Disorder and Suicidal Behavior 667
Zoltan Rihmer and Peter Pestality
Despite the fact that the nosologic position of bipolar II disorder
continues to be debated, several lines of research indicate that it
is a distinct nosologic category that should be separated from
both bipolar I and unipolar major depression. This review of the
CONTENTS ix
authors and others work demonstrates that the lifetime risk of
suicide attempts is highest in bipolar II and lowest in unipolar
patients, whereas risk is intermediate in bipolar I patients. More¬
over, two reports show that bipolar II patients are over repre¬
sented among suicide victims. Clinicians must take great care in
not missing this diagnosis, which, when untreated, has ominous
prognostic implications.
Psychosocial Interventions for Bipolar Disorder 675
Ann M. Callahan and Mark S. Bauer
The limitations of pharmacotherapy and the emergence of data
supporting a role for psychosocial factors in the course of bipolar
disorder have led to increased interest in the use of psychosocial
interventions to improve outcomes. Although this area of study
has suffered from a lack of systematic data, preliminary evidence
suggests that the combined use of psychosocial interventions and
medication is superior to pharmacologic treatment alone. Further
research is necessary to identify and the psychosocial risk factors
associated with bipolar disorder to design effective interventions
to diminish their effects and improve outcome. The introduction
of formal, manual based psychotherapeutic interventions that in¬
clude specific educational components has been particularly
promising.
The Role of Bipolarity in Depression in the Family
Practice Setting 689
J. Sloan Manning, Radwan F. Haykal, and
Hagop S. Akiskal
The literature suggests that bipolar spectrum disorders are more
prevalent than previously thought but still poorly recognized. In
the primary care setting, this poor recognition is largely the result
of an insensitive, cross sectional approach and clinicians lack
of familiarity with the phenomenology of bipolar II. Failure to
recognize the role of bipolarity in depressive illness is more often
a cause of the poor outcome of this illness in this setting than
under dosing with antidepressants. Hypomania is easily missed
in clinical evaluations and, as currently defined by DSM IV, may
not represent the most diagnostic marker for all variants of bipo¬
lar illness: Mood lability and energetic activity, temperamental
traits embodied in the construct of cyclothymia, have emerged as
more specific. Given emerging data that as much as one third of
depressions in both psychiatric and primary care settings belong
to the soft bipolar spectrum, practitioner education on the neces¬
sity to consider course, temperament, and family history in the
approach to depression may improve the identification of bipolar
spectrum disorders and limit unproductive or potentially harmful
antidepressants use unprotected with mood stabilizers.
Index 705
Subscription Information Inside back cover
X CONTENTS
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| spelling | Bipolarity: beyond classic mania Hagop S. Akiskal ... guest ed. Philadelphia [u.a.] Saunders 1999 XII S., S. 517 - 711 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier The psychiatric clinics of North America 22,3 Trouble bipolaire Bipolar Disorder therapy Manic-depressive illness Manisch-depressive Krankheit (DE-588)4037350-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Manisch-depressive Krankheit (DE-588)4037350-2 s DE-604 Akiskal, Hagop S. Sonstige oth The psychiatric clinics of North America 22,3 (DE-604)BV000003374 22,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008761776&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Bipolarity: beyond classic mania The psychiatric clinics of North America Trouble bipolaire Bipolar Disorder therapy Manic-depressive illness Manisch-depressive Krankheit (DE-588)4037350-2 gnd |
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| title | Bipolarity: beyond classic mania |
| title_auth | Bipolarity: beyond classic mania |
| title_exact_search | Bipolarity: beyond classic mania |
| title_full | Bipolarity: beyond classic mania Hagop S. Akiskal ... guest ed. |
| title_fullStr | Bipolarity: beyond classic mania Hagop S. Akiskal ... guest ed. |
| title_full_unstemmed | Bipolarity: beyond classic mania Hagop S. Akiskal ... guest ed. |
| title_short | Bipolarity: beyond classic mania |
| title_sort | bipolarity beyond classic mania |
| topic | Trouble bipolaire Bipolar Disorder therapy Manic-depressive illness Manisch-depressive Krankheit (DE-588)4037350-2 gnd |
| topic_facet | Trouble bipolaire Bipolar Disorder therapy Manic-depressive illness Manisch-depressive Krankheit Aufsatzsammlung |
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