Algorithms for the treatment of bipolar manic-depressive illness
Available from: Jared W Young
- "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
Available from: Jenifer L Culver
- "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: Psychomotor agitation, a common clinical feature of major depression, may first emerge or intensify during pharmacotherapy. Whether agitation is part of the underlying course of depression or iatrogenic complicates treatment planning. We analyzed data from blinded clinical trials involving 4,737 patients with major depression assigned to a selective serotonin reuptake inhibitor (fluoxetine), a comparator antidepressant (usually a tricyclic antidepressant [TCA]), or placebo. Item 9 of the Hamilton Depression Rating Scale was used to assess the degree of psychomotor agitation. The vast majority of depressed patients exhibited baseline psychomotor agitation. The rate of increased agitation from baseline during acute pharmacotherapy was comparable between fluoxetine and either placebo or TCAs. Substantial emergence of psychomotor agitation also occurred at a similar incidence across the three treatment groups and typically appeared within the first 3 wk. Improvement in agitation was significantly more prominent (P < 0.001) among fluoxetine-treated than among placebo-treated patients. Fluoxetine-treated patients demonstrated numerically superior improvement rates compared with TCA-treated patients; however, this difference was not significant. Data derived from this large series of clinical trials suggested no evidence that either fluoxetine or TCAs induced psychomotor agitation at rates exceeding the natural course of the disorder over time (placebo cohort). On the contrary, pharmacotherapy with either fluoxetine or TCAs was typically associated with diminished agitation, probably as part of the response pattern of depression.
Depression and Anxiety 01/1996; 4(6):294-311. DOI:10.1002/(SICI)1520-6394(1996)4:6<294::AID-DA6>3.0.CO;2-C · 4.41 Impact Factor
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