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    • "While the number of drugs licensed for treatment of manic episodes has grown substantially over the past decade (Smith et al., 2007), there remains a dearth of consensus in current clinical practice regarding the optimal treatment for mania (Bourin et al., 2005). Some groups recommend monotherapy with a mood stabilizer or atypical antipsychotic as a firstchoice treatment option for BD mania (Suppes et al., 1995; Bauer et al., 1999), while others advocate combination treatment with these two classes of drugs, especially in the case of severe manic episodes (APA, 2002). While older clinical trials for mania medications were conducted with less rigorous methodological requirements and did not necessarily satisfy current scientific criteria (comparative, randomized, doubleblind design), more recent studies have validated the efficacy of a variety of anti-manic drugs (Grunze et al., 2009). "
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    ABSTRACT: Mania has long been recognized as aberrant behaviour indicative of mental illness. Manic states include a variety of complex and multifaceted symptoms that challenge clear clinical distinctions. Symptoms include over-activity, hypersexuality, irritability and reduced need for sleep, with cognitive deficits recently linked to functional outcome. Current treatments have arisen through serendipity or from other disorders. Hence, treatments are not efficacious for all patients, and there is an urgent need to develop targeted therapeutics. Part of the drug discovery process is the assessment of therapeutics in animal models. Here we review pharmacological, environmental and genetic manipulations developed to test the efficacy of therapeutics in animal models of mania. The merits of these models are discussed in terms of the manipulation used and the facet of mania measured. Moreover, the predictive validity of these models is discussed in the context of differentiating drugs that succeed or fail to meet criteria as approved mania treatments. The multifaceted symptomatology of mania has not been reflected in the majority of animal models, where locomotor activity remains the primary measure. This approach has resulted in numerous false positives for putative treatments. Recent work highlights the need to utilize multivariate strategies to enable comprehensive assessment of affective and cognitive dysfunction. Advances in therapeutic treatment may depend on novel models developed with an integrated approach that includes: (i) a comprehensive battery of tests for different aspects of mania, (ii) utilization of genetic information to establish aetiological validity and (iii) objective quantification of patient behaviour with translational cross-species paradigms.
    British Journal of Pharmacology 03/2011; 164(4):1263-84. DOI:10.1111/j.1476-5381.2011.01318.x · 4.84 Impact Factor
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    • "Once acute mood stabilization is achieved, the major focus of long-term maintenance treatment is to prevent relapse, reduce new-onset comorbidities, lower suicide risk, limit adverse effects, and optimize function. Patients who remain well on longterm treatment should be encouraged to continue their regimen to prevent relapse, which is frequent if therapy ceases—a 50% relapse rate has been reported within 5 months of abruptly stopping lithium (Suppes et al., 1995). If patients cease treatment, they are also at elevated risk of suicide (Tondo et al., 2000). "
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    ABSTRACT: Bipolar disorder is a chronic, severe condition commonly causing substantial mortality and psychosocial morbidity. Challenges in recognition can delay the institution of appropriate management, whereas misdiagnosis may initiate pharmacologic interventions that adversely affect the condition's course. Pharmacotherapy remains the foundation of treatment. In addition to efficacy, tolerability is an important consideration in medication choice, particularly for long-term maintenance because of its impact on adherence. Mood stabilizers are the classic treatments for bipolar disorder. Newer agents such as atypical antipsychotics may offer efficacy and/or tolerability advantages compared with other medications. The role of antidepressants in bipolar disorder remains controversial. Growing evidence indicates that adjunctive psychosocial interventions improve long-term functioning; consequently, psychologists are becoming increasingly involved in the long-term care of patients with bipolar disorder. This review seeks to update psychologists and related healthcare professionals on recent advances and the current limitations in the diagnosis and treatment of bipolar disorder.
    Journal of Clinical Psychology 01/2007; 63(1):73-92. DOI:10.1002/jclp.20333 · 2.12 Impact Factor
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    ABSTRACT: Theoretical guidelines on the biological treatment of a manic episode differ noticeably from everyday practice, especially in Europe. International guidelines stress the importance of monotherapy, either with lithium, anticonvulsive or antipsychotic agents, depending on the authors and the clinical picture. In some situations, it is recommended to associate an antipsychoticagentanda mood-stabilizer. In the last decade, antipsychotic agents have been mentioned more and more in these guidelines, while lithium has declined in importance. Respective characteristics and specific indications of the different antipsychotic agents have not been fully elucidated yet; nevertheless, some of these have been studied more than others. In practice the situation is quite different, polytherapy is frequent, including classical neuroleptic agents, and for periods that far exceed the duration of a manic episode, despite side-effects and contra-indications particularly frequent in this population. There is no evidence supporting the use of these agents either in the treatment of a manic episode or in the subsequent prophylaxis, but theoretical recommendations do not always reflect the practical situations. Taking this into account and in particular evaluating indications and conditions of polytherapy are critical issues in future studies on the biological treatment of a manic episode; however methodological problems are complex.
    L EncĂ©phale 31(4 Pt 1):502-6. · 0.70 Impact Factor
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