Bipolar Disorder Uncovered

Bipolar Disorder Uncovered

If you're wanting to learn about bipolar disorder... Then this may be the most important letter you'll ever read! You are about to take an in-depth look at bipolar disorder. It's all you need to know about bipolar disorder to help you or a loved one lead a normal life. It doesn't matter if you or a loved one have been recently diagnosed or been struggling with bipolar disorder for years - This guide will tell you everything you need to know, without spending too much brainpower!

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Married To Mania

This eBook is the key to knowing if you are married to a bipolar spouse, and gives you the keys to what to do about it. Often, being married to a bipolar spouse can be one of the hardest things you go through in your life because emotions in your house can change drastically, and completely without warning. This book gives you the tools to deal with unexpected anger outbursts and guilt that many spouses feel. This book will teach YOU how to deal with feelings of guilt that you may feel towards yourself, even though you have done everything you possibly can to make your marriage work. When you get this eBook, you can order a physical copy of the book and get FREE shipping. Also, you get two bonus eBooks when you order: The Spouse's Guide to Bipolar Disorder Vocabulary, which give you the tools you need to talk to doctors and psychiatrists, and The Bipolar Disorder Rolodex which gives you the latest in bipolar disorder research. It is hard to go through a bipolar marriage without help; now you don't have to.

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Stop With Bipolar Disorder

This ebook guide teaches you how to keep your symptoms of bipolar disorder under control and have a manageable, excellent life even with bipolar symptoms. You will be able to stop engaging in destructive behavior, get your emotions under control, and handle stress in the way that you usually envy everyone else doing. It is not fair that you are afflicted with this; bipolar disorder is under-diagnosed and tends to affect your live and lives of those you love in a powerful, often negative way. You can put that behind you now. You no longer have to live that way. This ebook guide teaches you how to tell your negative symptoms to take a hike, and MAKE them do so. You do not have to feel guilt over your disorder. You cannot help it. But now, we can help you control it, and manage your symptoms so you can have the normal life you deserve. Read more here...

Bipolar Disorder Stop Summary

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Schizophrenia bipolar disorder and major depressive disorder

All three major psychiatric disorders, schizophrenia, bipolar disorder (BP) and major depressive disorder (MDD) affect brain cytoarchitecture. Along with numerous histopathological signals of neuronal malfunction (e.g. reduction in neuronal size, dendritic length and dendritic spines density), these diseases also affect glial cells. There are some indications for loss of astrocytes and GFAP expression in schizophrenia, BP and MDD. In BP and MDD, significant decreases in the numbers and volume of astroglial cells were detected in prefrontal and

Bipolar disorders

Bipolar disorders is the name given to a group of mental disorders characterized by extreme fluctuations in i- Bipolar disorder not otherwise specified Bipolar disorders Disorders characterized by wide fluctuations in mood. mood. People diagnosed with bipolar disorders experience moods ranging from deepest depression to mania, often with periods of less extreme moods, or even emotional stability, in between.

Borderline personality disorder

Borderline personality disorder (BPD) is a mental disorder characterized by disturbed and unstable interpersonal relationships and self-image, along with impulsive, reckless, and often self-destructive behavior. Providing effective therapy for the borderline per- on sonality patient is a necessary, but difficult, challenge. ali The therapist-patient relationship is subject to the same inappropriate and unrealistic demands that borderline is personalities place on all their significant interpersonal rd relationships. They are chronic treatment seekers who r become easily frustrated with their therapist if they feel they are not receiving adequate attention or empathy, and symptomatic anger, impulsivity, and self-destructive behavior can impede the therapist-patient relationship. However, their fear of abandonment, and of ending the therapy relationship, may actually cause them to discontinue treatment as soon as progress is made.

Negative Study Bias What Journalists Ignore

Conrad, who has been tracking genetics coverage in 5 major US papers and 3 major newsmagazines followed the reporting of two such stories, a 1987 study about the Old Order Amish and a gene for manic depression and a 1990 study about a link between alcoholism and the dopamine D2 receptor. Both stories received major attention in the print media. But while the New York Times reported later studies discounting the findings of the manic depression gene story, the other papers and the newsmagazines either did not report the new evidence at all or only did so years later as part of another article.

Causes and symptoms

There is some indication that AS runs in families, particularly in families with histories of depression and bipolar disorder. Asperger noted that his initial group of patients had fathers with AS symptoms. Knowledge of the genetic profile of the disorder, however, is quite limited as of 2002.

Clinical features and epidemiology

Unipolar depression (UPD) is so called because it consists of episodes of depressed mood whereas bipolar disorder (BPD) presents as episodes of both mania and depression. (A minority of patients with bipolar disorder have episodes of mania and no depressive episodes, but in terms of course, outcome, treatment response and pattern of illness in relatives they resemble typical bipolar disorder but a less severe form, so called bipolar disorder II, affects up to 2 of the general population and there is a slight female preponderance.

Internalizing Disorders Anxiety Disorders

Unhappiness or wide swings in mood from sadness to elation. The two most common mood disorders in childhood are major depressive disorder (MDD) and dysthymic disorder (DD APA, 2000). MDD and DD are related many children with DD eventually develop MDD, and some children may experience both disorders (Lewinsohn, Rohde, Seeley, & Hops, 1991). A third mood disorder, bipolar disorder, is rare in children, although there is growing interest in this problem in young people (Carlson, Bromet, & Sievers, 2000 Geller & Luby, 1997). In the sections to follow, we limit our discussion to anxiety disorders, highlighting many of the same features that we covered for ADHD. Once again, issues that we raise in discussing anxiety disorders have relevance for other childhood disorders as well.

ARA014418 in Psychiatry

The therapeutic potential of GSK-3 inhibitors as an antidepressant approach has been demonstrated by the ability of AR-A014418 to affect behavioral changes in animal models. In rats, administration of AR-A014418 reduced immobility time in forced swim tests 62 . In addition the specificity of this effect is supported by studies where AR-A014418 inhibited spontaneous as well as amphetamine-induced activity. These behavioral changes are consistent with the effects of current antidepressant therapies, thus suggesting that small-molecule GSK-3 inhibitors may be useful in the treatment of bipolar disorder and depression. Thus, AR-A014418 provides an important research tool to investigate the and therapeutic potential of GSK-3 inhibition in bipolar disorder, depression, and Alzheimer's disease as well as other neurodegenerative disorders.

Critique Of Clinical Judgment

Although mental health professionals were sometimes more accurate than beginning graduate students, this was not always the case. In one study (Whitehead, 1985), psychologists, first-year clinical psychology graduate students, and fully trained clinical psychology graduate students were instructed to make differential diagnoses on the basis of Rorschach or MMPI results. For example, one task they were given was to differentiate patients with schizophrenia from those with bipolar disorder. The first-year graduate students had received training in the use of the MMPI, but they had not yet received training in the use of the Rorschach. For this reason, the only Rorschach data given to beginning graduate students were transcripts of the Rorschach sessions. In contrast, the Rorschach data given to psychologists and fully trained graduate students included transcripts, response location sheets, and Rorschach scores (using the Comprehensive System Structural Summary Exner, 1974). In general,...

Genetic factors and mental disorders

In recent years, mental health professionals have become increasingly aware of the importance of genetic factors in the etiology (causes) of mental disorders. Since the Human Genome Project began its mapping of the entire sequence of human DNA in 1990, the implications of its findings for psychiatric diagnosis and treatment have accumulated rapidly. A new subspecialty known as biological psychiatry (also called physiological psychology or psychiatric genetics) has emerged from the discoveries of the last two decades. Biological psychiatry got its start in the late 1980s, when several research groups identified genes associated with manic depression and schizophrenia respectively. These studies ran into difficulties fairly quickly, however, because of the com Mental disorders almost always involve more than one gene. Studies have shown that one mental disorder can be caused by different genes on different chromosomes in different populations. For example, one study in the late 1980s...

Introduction To Mood Disorders And Limitations Of Current Treatments

Bipolar disorder and unipolar depression are classified as mood disorders. They are common, severe, and chronic illnesses. Depression is typified by a depressed mood, anhedonia (inability to experience pleasure), feelings of worthlessness or excessive guilt, impaired sleep (either insomnia or hyper-somnia), cognitive and concentration deficits, psychomotor changes, recurrent thoughts of death or suicide, and a variety of neurovegetative symptoms. In bipolar disorder, patients typically alternate (albeit not in a one-to-one manner) between episodes of depression (mostly indistinguishable from unipolar depression) and episodes of mania, which is characterized by a heightened mood, hyperaroused state, racing thoughts, increased speed and volume of speech, quicker thought, brisker physical and mental activity levels, inflated self-esteem, grandiosity, increased energy (with a corresponding decreased need for sleep), irritability, impaired judgment, heightened sexuality, and sometimes...

Contemporary Theories Of Personality Disorders And Treatment

The interrelationship among biologically based mental disorders and personality organization and type is a topic of tremendous importance to clinicians. Often, clinical syndromes that are considered to have a heavy biological loading such as schizophrenia and affective disorders, especially bipolar disorder, are treated in isolation without focus on the personality adaptation. Both clinical observation and experience underscore the importance of considering the personality as a central component of any clinical syndrome. For example, the personality system of an individual predisposed to psychiatric disorders will have a major impact on the treatment process. The manner in which an individual understands and accepts the constraints of chronic biologically based psychiatric disorder is highly contingent on the individual's personality and defensive structure. Whether medications will be taken as prescribed, the meaning of medication, and the acceptance of their limitations are central...

Cognitive Therapy for Affective Disorders

Trials, effect sizes are considerable compared to no treatment controls, with about half of the intent-to-treat patients showing full recovery (Hollon & Shelton, 2001). Some studies suggest cognitive therapy has particular relapse prevention effects (see, for example, Evans et al, 1992). More recently there have been important developments for recurrent and severe depression (McCullough, 2000) and for the prevention of depression relapse in individuals at high risk by virtue of their history of recurrent depression (Jarrett et al., 2001 Segal, Williams & Teasdale, 2002). Extensive clinical expertise has been invested in the development of cognitive therapy for bipolar disorder (Basco & Rush, 1996 Newman et al., 2002) but it would be premature to comment on the emerging outcome literature (for example, Lam et al., 2000) although preliminary studies suggest that cognitive therapy may prove to be an efficacious psychotherapy for people diagnosed with bipolar disorder. A large scale trial...

Mental Illness and Substance Abuse

The prevalence of serious mental illness and substance abuse is high among homeless persons. In a nationwide U.S. survey of homeless people, 39 had mental health problems, 50 had an alcohol and or drug problem, and 23 had concurrent mental health and substance use problems (Burt, 2001). Common psychiatric diagnoses among homeless people include major depression, bipolar disorder, schizophrenia, and personality disorders. A systematic review of the prevalence of schizophrenia in homeless persons found rates ranging from 4 to 16 and a weighted average of 11 in the ten methodologically strongest studies (Folsom and Jeste, 2002). Characteristics associated with a higher prevalence of schizophrenia were younger age, female sex, and chronic homelessness. Marked cross-national variation is seen in the prevalence of schizophrenia, with prevalence rates of 23-46 reported among homeless people in Sydney, Australia (Teesson, et al., 2004).

Role Of Mutual Empathy In The Therapeutic Process

If, however, we are empathically failed, misunderstood, humiliated, violated, or abused and we attempt to protest or to register our injury and we are not responded to but are ignored, further hurt, punished, and so forth, we learn that we cannot authentically represent ourselves in this relationship. if this occurs in a relationship with a powerful and important other (e.g., parent, teacher, boss) on whom we are dependent, we begin to distort our experience to try to fit in. We begin to deny our own pain to be accepted by this other person. As a result, we disconnect from ourselves. As Gilligan (1982) notes, we begin to keep ourselves out of relationship to stay in relationship. We move out of authenticity to stay in the semblance of connection. Authentic connection, however, suffers both our connection with the other and the connection with our own experience are weakened. We can trace the effect of chronic disconnection most clearly in cases of childhood abuse, the most obvious and...

The Rationale For Adjunctive Psychological Treatments

Bipolar disorder has a median age of onset in the mid-20s, but most individuals report that they experienced symptoms or problems up to 10 years before diagnosis. Thus, the early evolution of BP may impair the process of normal personality development or may mean that the person starts to employ maladaptive behaviours from adolescence onwards. Co-morbid anxiety disorders, including panic and post-traumatic stress disorder (PTSD) and other mental health problems are common accompaniments of BP and as many as 40 of subjects may have inter-episode sub-syndromal depression (Judd et al., 2002). Although many individuals manage to complete tertiary education and establish a career path, they may then experience loss of status or employment after repeated relapses. One year after an episode of BP, only 30 of individuals have returned to their previous level of social and vocational functioning. Interpersonal relationships may be damaged or lost as a consequence of behaviours during a manic...

Psychological Functioning In People With Intellectual Disabilities Mental Illness And Dementia

With a diagnosis of schizophrenia (or one of its variants) or an affective disorder (such as severe depression), or bipolar disorder (manic depression). (For details of the clinical features of these conditions, see sections 4 and 5, of Gelder et al. (2000). For personal accounts of the experience of mental illness, see British Psychological Society (2000) and Solomon (2002)). About 40 of people who experience a single episode of mental illness recover fully. Most of the remainder make at least a partial recovery, although they may continue to need treatment and support at times only a small minority require assistance for almost all their lives (Kuipers and Bebbington, 1987).

Current theories about the origin of mental disorders

Genetics is at this time an important area of research for psychiatric disorders. For example, a specific gene has been associated with bipolar disorder (also known as manic-depressive disorder), but unfortunately, the switch that controls the expression of the disorder is still unknown. It is presently thought that many genes go into the expression or nonexpression of any human characteristic, such as a facial feature or a certain aspect of mental health. Research done on identical twins has provided strong support for a genetic component in the development of schizophrenia. For instance, the average person in the United States has a 1 chance of developing schizophrenia, while the identical twin of a person diagnosed with schizophrenia has a 50 chance, even if he or she has been reared by adoptive parents. Other researchers who are studying schizophrenia have found that during embryonic development, there are nerve cells that do not migrate to their proper position in the...

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a medical procedure in which a small, carefully controlled amount of electric current is passed through the brain to treat symptoms associated with certain mental disorders. The electric current produces a convulsion for the relief of symptoms associated with such mental illnesses as major depressive disorder, bipolar disorder, acute psychosis, and catatonia. The American Psychiatric Association's Practice Guidelines for the Treatment of Psychiatric Disorders discusses the use of ECT in the treatment of major depressive disorder, bipolar disorder and schizophrenia. Electroconvulsive therapy is administered to provide relief from the signs and symptoms of these and occasionally other mental illnesses. ECT is used routinely to treat patients with major depression, delusional depression, mania, and depression associated with bipolar dis

Crystal Structures Of Gsk30 Inhibitor Complexes

GSK-3 has been considered a target for adult onset diabetes 34-36 , stroke 37,38 , Alzheimer's disease 39,40 , bipolar disorder 41 , and schizophrenia 42,43 . The ATP binding site has been the preferred site for kinase drug design and the crystallization of inhibitors with GSK-3 P is relatively straightforward. Unphosphorylated protein and ligand readily form diffracting crystals when combined with a mixture of PEG and salt (e.g., 5 ). The PEGION screens from Hampton Research or Nextal Biotechnologies yield crystals under multiple conditions. The crystals typically have the same space group as the native unliganded protein, although exceptions have been observed (e.g., the GSK-3P complex with 6-bromoidurubin, PDB 1UV5 44 ). The space group is P212121 with unit cell dimensions 83, 86, and 127 A, and 90 angles, and there are two GSK-3P inhibitor complexes in the asymmetric unit. The Protein Data Bank contains seven crystal structures of GSK-3P in complex with non-ATP inhibitors, all of...

Bipolar I and II Dysthymic and Cyclothymic Disorders

Differential incidence of Bipolar Disorder I associated with race or ethnicity has not been reported (DSM-IV, 1994, p. 352). Some evidence exists suggesting that clinicians may overdiagnose Schizophrenia rather than Bipolar Disorder I in some ethnic groups (DSM-IV, 1994, pp. 352-353). The DSM-IV (1994) did not provide a description of cultural variants for Bipolar II, Dysthymic, and Cyclothymic Disorders. A major characteristic of Bipolar II and Cyclothymic Disorders is the presence of hypomanic symptoms. As noted by Castillo (1997), these symptoms are culturally accepted in some cultural contexts. For example, members of the Hindu culture generally engaged in meditative trances to achieve a permanent hypomanic state during their religious practices (Castillo, 1997, p. 219). In the case of Dysthymic Disorder, being depressed most of the time over at least two years could be the result of specific cultural variables such as racial discrimination and severe poverty (Castillo, 1997...

Lithium Salts As Medication

As mentioned, lithium represents a common treatment for bipolar disorder. Lithium salts were first used therapeutically in the nineteenth century as remedies for sleeplessness and gout. Since the report of their efficacy in the treatment of bipolar disorder in the late 1940s by John Cade, lithium has been widely used in the treatment of acute manic symptoms and mood episode prophylaxis 21 . As mentioned, a number of double-blind studies have confirmed lithium's efficacy both in the acute treatment of mania, and for mania prophylaxis 14 . Further, multiple studies have suggested that lithium may be useful for both the acute and prophylactic treatment of depression (see 22 and 23 for meta-analysis and review). Unfortunately, many of the studies addressing monotherapy antidepressant effects had with some methodological shortcomings in particular, low sample sizes and the use of crossover study designs. In clinical experience, lithium's antidepressant effects as monotherapy may be modest,...

Cns Disorders And Gsk3 Inhibitor Lithium

Lithium and valproic acid are mood stabilizers, and they are widely used in the chronic treatment of bipolar disorders. Lithium ions directly inhibit GSK-3 35 , while valproic acid inhibits GSK-3 activity in relevant therapeutic concentrations in human neuroblastoma cells 36 . The mechanism of action by which lithium exerts its therapeutic effects is not known, but therapeutic efficacy is observed after several days of treatment. It is therefore conceivable that the acute effects on GSK-3 result in changes in gene regulation and cellular changes that could affect the neuronal plasticity over time 37,38,39 . Lithium inhibits at least four phosphomonoesterases (including inositol monophosphatase) 40 , phosphoglucomutase 41,42 , and GSK-3 35,47 . However, GSK-3 is significantly inhibited at therapeutic lithium concentrations (0.6-1.2 mM) 10,39,43 . The Ki for lithium's inhibition of GSK-3 is approximately 1-2 mM 35 . Lithium's inhibition of GSK-3 is thought to be by competing for...

Molecular Effects Of Lithium

Much work, crossing many decades, has attempted to focus attention on discovering lithium's relevant therapeutic target 29-33 . The hope is that a new generation of medications can be developed that share lithium's therapeutic target without affecting those targets responsible for the side effects and narrow therapeutic window of the drug. While development of a novel lithium mimetic will probably not cure bipolar disorder or depression, it is likely revolutionize the tolerability, as SSRIs did for the treatment of depression in the 1980s (before which time tricyclic and MOAI medications, which have more severe side effects and are dangerous in overdose, were first-line treatments).

Gsk3 Inhibitors As Therapeutic Agents

Since the mid-1990s there has been a near exponential rise in the level of GSK-3-related research focusing on its implication in apoptosis, type 2 diabetes, cancer, bipolar disorders, stroke, and neurodegenerative diseases. As a consequence the therapeutic potential of GSK3 inhibitors has become a major area of pharmaceutical interest (reviewed in 10 ). Nearly half a century after the discovery that lithium salts were effective in treating manic-depression illness, GSK-3 was discovered as one of lithium's main targets 11 . Since then lithium has been widely used as a pharmacological inhibitor of GSK-3 12 .

Child And Adolescent Disorders An Overview

The APA's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR APA, 2000) recognizes the uniqueness of childhood disorders in a separate section for disorders usually first diagnosed in infancy, childhood, or adolescence. However, this designation is viewed primarily as a matter of convenience, recognizing that the distinction between disorders in children and those in adults is not always clear. For example, although most individuals with disorders display symptoms during childhood and adolescence, they sometimes are not diagnosed until adulthood. In addition, many disorders not included in the childhood disorders section of DSM-IV-TR often have their onset during childhood and adolescence, such as depression, schizophrenia, and bipolar disorder. Characterized by extreme, persistent, or poorly regulated emotional states such as excessive unhappiness or wide swings in mood from sadness to elation. A disturbance in mood is the predominant...

Process Of Therapeutic Change

Jillian had been diagnosed with Bipolar Disorder (aggressiveness without mania) on two previous hospitalizations and presently met criteria for Major Depressive Disorder, severe. Despite the affective volatility and instability that was suggestive of Borderline Personality Disorder (BPD), Jillian was better described by the label Oppositional Disorder a DSM-IV category closely related to the description of Passive Aggressive Personality Disorder (PAG) from the DSM-III-R (APA, 1987). Her patterns that were independent of mood disorder and that supported this label included the following specific DSM-IV items (1) She often lost her temper, (3) she typically refused to comply with rules and requests, (5) she frequently blamed others for her mistakes or misbehavior, (6) she was touchy and easily annoyed by others, (7) she was often angry and resentful. The proper way to define the PAG category has been so controversial that in the DSM-IV, it was moved from Axis II in the DSM-III-R to a...

Newer Target Of Lithium Direct And Indirect Inhibition Of Glycogen Synthase Kinase

In 1996 it was discovered that lithium inhibited the enzyme glycogen synthase kinase-3 (GSK-3) 39,40 , a highly conserved protein serine threonine kinase first characterized for its role in glycogen synthesis. These findings raised the possibility that GSK-3 inhibition might play a role in the treatment of bipolar disorder and depression. However, the past two years has seen the emergence of exciting new biochemical, pharmacological, genetic, and rodent behavioral studies, all of which support the hypothesis that inhibition of GSK-3 represents a therapeutically relevant target for lithium's mood stabilizing properties. Furthermore, as we discuss, more recent preclinical evidence implicates the modulation of GSK-3 in either the direct or downstream mechanism of action of many other mood stabilizer and antidepressant medications currently in use (Table 7.1).

Historical background

Over the past 50 years, there have been fundamental changes in the system of mental health care in America. In the 1950s, mental health care for persons with severe and persistent mental illnesses (like schizophrenia, bipolar disorder, severe depression, and schizoaffective disorder) was provided almost exclusively by large public mental hospitals. Created as part of a reform movement, these state hospitals provided a wide range of basic life supports in addition to mental health treatment, including housing, meals, clothing and laundry services, and varying degrees of social and vocational rehabilitation.

Therapeutic Applications Lithium Or Other Inhibitors Of Gsk3

Considering all of the advantages and weaknesses of lithium, will it be replaced by new inhibitors of GSK-3 For new therapeutic applications directed at peripheral organs, such as diabetes, new GSK-3 inhibitors have a reasonable chance of more effectively producing larger inhibition of GSK-3 than lithium. However, as discussed above, for central actions, such as in bipolar disorder or neurodegenerative diseases, it will be challenging to attain efficacy, tolerability, and safety matching lithium.

Rodent Behavioral Models

Recent evidence suggests that many of the behavioral effects of lithium in rodent models are due to inhibition of GSK-3. Dopamine systems play critical roles in regulating motoric activity and also motivational and reward circuits. Loss of motivation is one of the central features of depression and anhedonia extreme hedonia are among the most defining characteristics of bipolar depression and mania, respectively. Further the changes in activity present in bipolar disorder are additional characteristics of the illness, ranging from robust immobility to the profound hyperactivity of manic states. Lithium attenuates amphetamine hyperactivity in rodents, and represents a well-studied and reproducible models of antimanic drug efficacy (see 128 for discussion). The hyperactivity is attenuated by antipsychotic drugs as well as anticonvulsants often utilized for the treatment of bipolar disorder 129 . It additionally has face validity amphetamine commonly precipitates manic episodes in...

Nonpsychotic Mood Disorders

Another kind of bipolar disorder included in DSM-IV is the cyclothymic type. Essentially, this diagnosis involves a mood disorder with periods of elation and depression that are considered less severe than in the bipolar disorder. In the dysthymic disorder, depression is the unipolar dimension to be considered and this diagnosis of the dysthymic disorder roughly corresponds to the reactive depression of DSM-II where the depression was designed in the personality to allay anxiety stimulated by a specific precipitating event. In addition, the reactive depression of DSM-II could be diagnosed in connection with a reaction to any recent event and did not require the two-year framework, in which the depression was sustained, that corresponds to the dysthymic disorder introduced in DSM-III and continued in DSM-IV. Using DSM-IV, any depression less severe than that enduring two years and meeting the other severity requirements of dysthymia requires the...

Cyclothymic disorder

Cyclothymic disorder, a symptomatically mild form of bipolar II disorder, involves mood swings ranging from mild depression to mild mania. It is possible for cyclothymia to go undiagnosed, and for individuals with the disorder to be unaware that they have a treatable disease. Individuals with cyclothymia may experience episodes of low-level depression, known as dysthymia periods of intense energy, creativity, and or irritability, known as hypomania or they may alternate between both mood states. Like other bipolar disorders, cyclothymia is a chronic illness characterized by mood swings that can occur as often as every day and last for several days, weeks, months, or as long as two years. Individuals with this disorder are never free of symptoms of either hypomania or mild depression for more than two months at a time.

Concluding Remarks

GSK-3 a and p have a plethora of functions that complicate assessment of these molecules as a target for therapy. There are multiple important pathological conditions in which GSK-3 is dysregulated including neurological disorders such as bipolar disorder, sleep disorders, Alzheimer's disease, and T2DM. In each of these conditions, inhibition of GSK-3 should provide relief of the driving forces of the diseases. The major concern, however, is that chronic inhibition of GSK-3 can also lead to activation of targets that are proliferative such as certain transcription factors and p-catenin, which is a human oncogene. To counter this concern, there are indications that the levels of inhibition required for effects on metabolic or neurological behaviors are much lower than required for stabilization and activation of p-catenin. Only 25 inhibition of total GSK-3 (as achieved in mice heterozygous for GSK-3P) is sufficient to phenocopy behavioral effects of lithium treatment in mice and to...

Other Applications

The success of IPT in treating unipolar mood disorders has led to its expansion to treat other psychiatric disorders. Frank and colleagues in Pittsburgh have been assessing a be-haviourally modified version of IPT as a treatment adjunctive to pharmacotherapy for bipolar disorder. Further, IPT is increasingly being applied for a range of non-mood disorders. There are intriguing applications of IPT as treatment for bulimia (Agras et al., 2000 Fairburn et al., 1993 Wilfley et al., 1993, 2000) and anorexia nervosa social phobia (Lipsitz et al., 1999), posttraumatic stress disorder, borderline personality disorder and other conditions. Life events, the substrate of IPT, are ubiquitous, but how useful it is to focus on them may vary from disorder to disorder. There have been two negative trials of interpersonal therapy for substance disorders (Carroll, Rounsaville & Gawin, 1991 Rounsaville et al., 1983), and it seems unlikely that an outwardly focused treatment such as IPT would be useful...

Affective Disorders

Bipolar disorder, in which the patient's mood fluctuates fairly regularly between mania and depression, is a classic pattern. During the manic phase of the illness, the patient is elated, overtalkative, and irritable motor activity increases and thoughts appear to be strange. In the depressive phase of the cycle, the patient is deeply despondent, sometimes stuporous, expresses feelings of guilt and self-deprecation, and complains of aches and pains. These same symptoms are present in psychotic depression, but without the bipolar mood swings.

Dual diagnosis

Dual diagnosis is a term that refers to patients who have both a mental health disorder and substance use disorder. It may be used interchangeably with co-occurring disorders or comorbidity. According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 10 million people in the United States will have a combination of at least one mental health and one substance abuse disorder in any twelve-month period. Substance abuse is the most common and significant co-occurring disorder among adults with such severe mental illnesses as schizophrenia or bipolar disorder. It may also be observed in individuals with mental health diagnoses that include depression, anxiety, post-traumatic stress disorder, or eating disorders. The term substance abuse refers to substance use disorders that range along a continuum from abuse to dependence or addiction. The prevalence of people with dual diagnoses became fully apparent to clinicians in the early 1980s. Initially,...


Gabapentin is used in combination with other antiseizure (anticonvulsant) drugs to manage partial seizures with or without generalization in individuals over the age of 12. Gabapentin can also be used to treat partial seizures in children between the ages of three and 12. Off-label uses (legal uses not specifically approved by the United States Food and Drug Administration FDA ) include treatment of severe, chronic pain caused by nerve damage (such as occurs in shingles, diabetic neuropathy, multiple sclerosis, or post-herpetic neuralgia). Studies are also looking at using gabapentin to treat bipolar disorder (also known as manic-depressive disorder). When gabapentin is used for bipolar disorder, the starting dose is usually 300 mg taken at bedtime. Depending on the patient's response, the dose can be increased every four to seven days. Many people receive maximum therapeutic benefit at 600 mg per day, although some people have required up to 4,800 mg per day.


Valproic acid, which is also available as a significantly better tolerated enteric-coated derivative (divalproex sodium) has clinical effects generally similar to those achieved by carbamazepine in the treatment of mania. It is approved by the U.S. FDA for treatment of acute mania associated with bipolar disorder. Fourteen case reports or case series focus on use in patients with BPSD and describe a total of 202 subjects. In the aggregate, approximately two-thirds of these subjects were reported to show improved agitation, with valproate doses ranging from a general low of about 500 mg day to a general maximal dose of 1,500 mg day, with levels typically ranging from 20 to about 100 mcg ml. Porsteinsson et al. (2001) reported on the first randomized, placebo-controlled, parallel group study of this agent, six weeks in length, in 56 nursing home residents who experienced dementia with agitation. The purpose of this study was not to prove efficacy but to establish effect size and clarify...


There are frequent exceptions to these general impressions, and it is important to appreciate that patients in the throes of a depressive or manic episode may give distorted accounts of their previous personalities. Another postulated mechanism is that depression results from inability to express hostility and aggression, so that these emotions are directed inward to produce self-blame and guilt. The learned helplessness model postulates that depression results from repeated failure to overcome problems by personal effort. Bipolar disorder tends to develop in those of cyclothymic personality.


To speculation that it plays a role in the pathogenesis of neurological disorders such as Parkinson's disease and migraine (Eisenhofer et al., 1999). A number of studies have used p-nitrophenol (SULT1A1-like activity) and dopamine (SULT1A3-like activity) to measure platelet SULT expression and have compared findings in patients with neurological disorders to control groups (Bongioanni et al., 1996 Marazziti et al., 1992, 1996). These studies have shown increased platelet SULT activity (both SULT1A1 and 1A3) in patients with obsessive-compulsive disorder (Marazziti et al., 1992, 1996), bipolar disorder (Marazziti et al., 1996), and Alzheimer's disease (Bongioanni et al., 1996). In contrast, decreased activity was observed in unipolar depression and migraine patients (Alam et al., 1997 Littlewood et al., 1982). While these studies suggest a role for SULT1As in neurological diseases, it must be pointed out that platelets are somewhat distant from the brain. Further, while a correlation...

Fantasy as Control

The construction of fantasies containing bold interpersonal confrontations and the successful expression of direct aggression or sexuality, which are often revealed in projective stories and even in inkblot responses, are frequently attempts to fulfill through imagination what the individual feels unable to perform in reality. In the construction of such fantasies, the impulses involved in direct assertion and overt expression of anger are controlled. The use of fantasy to control and manage urgent impulses, such as rage, can be an important safeguard in curtailing highly destructive behavior. On the other hand, the appearance of such fantasies in the protocol also raises the possibility that the patient may ultimately act-out. The intensity of the impulse and the nature of the patient's controls will determine whether behavioral expression is likely.


Hallucinations are a symptom of either a medical (e.g., epilepsy), neurological, or mental disorder. Hallucinations may be present in any of the following mental disorders psychotic disorders (including schizophrenia, schizoaffective disorder, schizophreniform disorder, shared psychotic disorder, brief psychotic disorder, substance-induced psychotic disorder), bipolar disorder, major depression with psychotic features, delirium, or dementia. Auditory hallucinations, in particular, are common in psychotic disorders such as schizophrenia.


The possibility of suicide is a component of depression. A minimal number of doses should be dispensed at any one time to minimize the potential for use as a suicide agent. Because the drug may lower the threshold for a manic episode among persons with bipolar disorders, it should be used only with caution and under close supervision.


Valproate (known as valproic acid in the uncarboxylated form), a short-chained fatty acid, had been used as an anticonvulsant in Europe for a decade before FDA approval in 1978 for the treatment of epilepsy in the United States. Interest in the potential efficacy of valproate for the treatment of bipolar disorder arose out of the suggestion that facilitating the activity of an inhibitory neurotransmitter like GABA may have antimanic effects. Early


Bipolar disorder is usually treated with both medical and psychosocial interventions. Psychosocial therapies address both psychological and social issues. highs and lows of bipolar disorder is Calcium channel blockers (nimodipine, or Nimo-top), typically used to treat angina and hypotension (low blood pressure), have been found effective, in a few small studies, for treating rapid cyclers. Calcium channel blockers stop the excess calcium buildup in cells that is thought to be a cause of bipolar disorder. They are usually used in conjunction with other drug therapies such as carbamazepine or lithium. rTMS, or repeated transcranial magnetic stimulation is a new and still experimental treatment for the depressive phase of bipolar disorder. In rTMS, a large magnet is placed on the patient's head and magnetic fields of different frequency are generated to stimulate the left front cortex of the brain. Unlike ECT, rTMS requires no anesthesia and does not induce seizures. Because bipolar...

Family education

When someone is diagnosed with a chronic illness, such as diabetes or heart disease, efforts are typically made by his her doctor not only to educate the individual directly affected by the illness, but to educate and involve his her family in treatment and care. Historically, this has not been the case with severe mental illnesses such as schizophrenia, major depression, bipolar disorder, or schizoaffective disorder.

Types of Impulses

Thus, in connection with anger, a continuum between feeling the emotion and overt behavioral action can be envisioned, with a range of events along the continuum that represents how anger may be expressed. First, the emotion of anger can be experienced by the person. This experience may be followed by rumination and fantasy. The sequence can build to covert, hostile verbal expressions such as sarcasm and insults. This sequence of the vicissitudes of anger may finally end with overtly destructive behavior. The main point, however, is to assess whether the patient is able to identify the object the person the target of the anger. Some individuals characteristically handle anger around only one part of this continuum. Where anger is experienced in the absence of action, for example, it is important to specify this tendency and also to determine the control mechanisms utilized. Similarly, if the person tends to be at the other end of the continuum where the anger is readily translated...

Crisis housing

The course of most serious mental illness (such as schizophrenia, bipolar disorder, severe depression, and borderline personality disorder) is cyclical, typically characterized by periods of relative well-being, interrupted by periods of deterioration or relapse. When relapse occurs, the individual generally exhibits florid symptoms that require immediate psychiatric attention and treatment. More often than not, relapse is caused by

Valproic acid

The United States Food and Drug Administration (FDA) recognizes valproic acid for the treatment of epilepsy and for mania that occurs with bipolar disorder (previously called manic-depressive disorder). Valproic acid is also approved for the prevention of migraine headaches. Valproic acid is effective in treating a variety of seizure types, which include simple and complex absence seizures, partial seizures, and clonic-tonic seizures (grand mal seizures). Valproic acid is effective in treating the manic episodes of patients with bipolar disorder. Patients who have bipolar disorder resulting from a head injury and patients who do not respond to or who cannot tolerate conventional lithium therapy (normally the therapy of choice for bipolar disorder) can be treated with valproic acid. In addition, valproic acid provides a 50 or greater reduction in the frequency of migraine headaches. Valproic acid is also safe and effective in preventing headaches that arise as a side effect of taking a...