Bipolar Disorder

While I sit in the third row of my synagogue on Saturday morning, reciting the traditional portions of the Sabbath service, I have running through my mind an additional and more intensely felt prayer-that none of my fellow congregants will approach me later to discuss their personal psychiatric care.

An Overview of Antipsychotic Use in Older Adults

The contents of this volume are, as the cover emphasizes, “real stories from real people.” Clinicians who practice in a setting that allows time to really listen to patients have already heard these stories. These would be clinicians who have learned that listening to small details in a patient’s history helps one recognize patterns not described in the DSM.

Houston, we have a problem. There is a critical shortage of psychiatrists. And the problem is not in Houston alone-it includes the entire state of Texas, and every other state in the union (Mid-town Manhattan, Boston’s Beacon Hill, and Sacramento Street in San Francisco might be exceptions).

Researchers who have spent their careers studying schizophrenia and mood disorders might be forgiven a bit of “biomarker envy.” At long last, it seems that the neurologists and neuropsychiatrists have developed some fairly sensitive and specific “lab tests” for Alzheimer’s Disease (AD).

I offer all of this as a way of describing how I became involved in intensive psychotherapeutic efforts with several adolescents who I then continued to see, often for many years following their inpatient experiences.

Fads in psychiatric diagnosis come and go and have been with us as long as there has been psychiatry. The fads meet a deeply felt need to explain, or at least to label, what would otherwise be unexplainable human suffering and deviance.

When I was an undergraduate studying molecular biology in the early 1990s when the Human Genome Project had just begun, my required coursework included several lectures on the ethical implications of sequencing, understanding, and ultimately being able to manipulate the “code of life.”

Many have challenged the claim of the APA/DSM-5 Task Force that the current process is the most “open process in the history of the manual.” Few have actually provided an argument or evidence of why this might, or might not, be so. What has changed dramatically in the DSM process since DSM-IV in 1994, and even DSM-IV-TR in 2000, is the rise of Internet culture and the “blogosphere.” What does this have to do with DSM-5?

As an officer of the APA, I was one of the prime movers of the limitations on, and vetting of, potential participants in the preparation of the DSM5.

Bipolar disorder is recognized as a serious disorder. It has an adverse impact on many areas of a child’s development-including cognitive, emotional, and social functioning. Children with BD are at significant risk for substance use and suicidality. Further identification of effective treatments is a pressing public health concern.

Almost the first memory I have of a physician is our family doctor at my bedside, leaning over to press his warm fingers against my neck and beneath my jaw. I’m 5, maybe 6 years old. I have a fever and a sore throat, and Dr Gerace is carefully palpating my cervical and submandibular lymph nodes.

A recent meta-analysis showed that diagnoses generated from clinical evaluations often do not agree with the results of structured and semistructured interviews-together called standardized diagnostic interviews (SDIs).

A vital consideration we learn in medicine is that continuing life support for a moribund patient past a certain point is harmful to the lives of all concerned.

Psychotropic drugs are big business: in 2009, roughly 300,000,000 prescriptions were written for these agents.

Transcranial magnetic stimulation (TMS) is noninvasive focused brain stimulation that uses pulsed magnetic fields. The underlying mechanism depends on the principle of electromagnetic induction, the process (discovered by Faraday in 1839) by which electrical energy is converted into a magnetic field and vice versa.1

Questions have also been raised about the extent of industry influence on the American Psychiatric Association’s diagnostic and treatment guidelines-namely, its DSM and Clinical Practice Guidelines.

In addition to their use in the management of epilepsy, anticonvulsants are indicated for management of bipolar disorder, mania, neuralgia, migraine, and neuropathic pain.

This is the second installment of a new series in which clinically relevant research is briefly discussed and, perhaps more important, a few tips on how to read and interpret research studies are presented. Your feedback, suggestions, and questions are eagerly solicited at rajnish.mago@jefferson.edu.

The overall effectiveness of electroconvulsive therapy (ECT) is well known, but its speed of action is much less talked about. Here I review what is known about the time course of action of ECT in depression.

Houston, we have a problem. There is a critical shortage of psychiatrists.

DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a “paradigm shift.” Work groups were instructed to think creatively, that everything was on the table. Accordingly, and not surprisingly, they came up with numerous pet suggestions that had in common a wide expansion of the diagnostic system-stretching the ever elastic concept of mental disorder. Their combined suggestions would redefine tens of millions of people who previously were considered normal and hundreds of thousands who were previously considered criminal or delinquent.

I often get asked if practical consequences should play an important role in DSM5 decisions. It was posed again yesterday in response to my blog "Bipolar II Revisited" which tangentially raised the issue.

Sometimes you spot a serious problem and figure out a very well-intended solution, only to discover eventually that your solution created as much trouble as the original problem. The workers on DSM5 have spotted an enormously worrying problem-the wild overdiagnosis of childhood bipolar disorder (BD) which has led to a massive increase in the use of antipsychotic and mood stabilizing medications in children and teenagers.

DSM5 suggests 2 changes that would make it much easier for an adult to get a first time diagnosis of Attention Deficit Disorder (ADD): 1) reducing the number of symptoms required for adults from 6 to 3; and 2) relaxing the requirement that the onset of symptoms must have occurred before age 7 (by allowing the onset to be up to age 12).

Almost the first memory I have of a physician is our family doctor at my bedside, leaning over to press his warm fingers against my neck and beneath my jaw. I’m 5, maybe 6 years old. I have a fever and a sore throat, and Dr Gerace is carefully palpating my cervical and submandibular lymph nodes. In my family, Dr Gerace’s opinion carried a lot of weight. It was the 1950s, and my mother did not quite trust those new-fangled antibiotics. She usually tried to haggle with the doctor over the dose-“Can’t the boy take just half that much?”-but even my mother would ultimately bow to Dr Gerace’s considered opinion.

DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a "paradigm shift.”

Mark Twain observed that "the past may not repeat itself, but it sure does rhyme." An unfortunate rhyme in psychiatric history is the recurrence of fad diagnoses. Childhood Bipolar Disorder is the most dangerous current bubble, with a remarkable forty-fold inflation in just one decade.

Avoid Surprises and Unintended Consequences

Diagnostic Dilemmas-Effective Treatment Approaches