Bipolar Disorder

The Emerging Role of GABAergic Mechanisms in Mood Disorders by Po W. Wang, M.D., and Terence A. Ketter, M.D. Gamma-aminobutyric acid is a major inhibitory neurotransmitter widely distributed in the mammalian central nervous system. Animal models of depression have pointed toward the importance of the GABA system in the pathophysiology of mood disorders. Thus, elucidating the GABAergic effects of benzodiazepines, mood stabilizers, antidepressants, and new anticonvulsants and antipsychotics may expand our understanding of mood disorder pathophysiology and potentially generate new targets for treatment.

Treating bipolar disorder in young patients can often result in aggravation, irritability or even reactivation depending on the type of medication used. What are typical examples of medication-induced rebound and what are the implications of these types of responses in children?

A discussion about new depression treatments with the chairperson of Stanford University’s department of psychiatry, Alan Schatzberg, M.D.

Individuals with schizophrenia are at greater risk for weight gain than the general population. From recent research, it appears that some of the second-generation antipsychotics may be more likely to cause weight gain than others. Recommendations for treatment strategies are provided.

Although lithium is still a first-line treatment for bipolar disorder, many psychiatrists are reluctant to use it due to blood monitoring requirements. The FDA has approved an in-office blood test that allows lithium blood levels to be obtained in minutes. The test is similar to glucose monitoring devices used for diabetes, and experts on BD are hoping it will increase the use of lithium, which has also been shown to lower the suicide rate among patients with this disorder.

While the utilization of clinical genotyping to determine drug response and dosage has been anticipated for many years, the actual utilization of screening for atypical drug metabolizers has only recently become a reality. What is the promise of this technology, as well as the limitations?

Suicidal behavior is a complex and multi-factorial phenomenon for which epidemiological genetics suggests a genetic basis that may be specific and independent from those implicated in the vulnerability to the psychiatric disorders associated with SB. Recently, new molecular biology tools have been designed to identify predisposition factors to complex disorders. One of the main goals of current studies is to specify the suicidal phenotype, as well as the intermediate phenotypes associated with these genes.

Many physicians who work in the emergency department (ED) consider the agitated patient the bane of their existence. These patients are frequently difficult to deal with, are uncooperative, and can bring an already busy ED to its knees. Although it is easy to understand why severely agitated patients are commonly placed in restraints or seclusion, it is essential that cooler minds prevail when an agitated patient presents to the ED. The patient should be treated with dignity, respect, and understanding. Because these patients often cannot express their feelings adequately, many who work in the ED do not realize that these patients do not like the feeling of being out of control.

Restraints and seclusion have been used for many years in emergency departments (EDs) and psychiatric emergency services (PESs), but anecdotal case reports and newspaper investigations as well as clinical advances have led to restrictions in their use.

Dr Zun has done an excellent job of reviewing the many controversies and complexities that surround the use of mechanical and chemical restraint as well as seclusion. He also shows us how many unanswered questions there are about such interventions. For example, an insightful psychiatric resident once raised the question of which intervention was more restrictive and stigmatizing: seclusion or restraint?

Sensitivity and specificity of a new bipolar spectrum diagnostic scale.

Recent research has shown environmental factors may increase the risk of schizophrenia in persons who may already have a genetic predisposition toward the illness.

Obsessive-compulsive disorder is a prevalent, disabling and chronic illness. Serotonin reuptake inhibitors are the first-line of treatment; however a large proportion of patients will have either a partial or nonresponse. This review outlines the strategies for treatment-resistant OCD, including augmentation agents, alternative monotherapies, intravenous strategies and newer nonpharmacologic somatic treatments under development.

Impulsive behaviors play an important role in both bipolar and substance abuse disorders. However, results of studies investigating this link are often ambiguous, in part, due to the multidimensional nature of the impulsivity construct and the fact that many studies use a single measurement technique. We describe a model of impulsivity characterized by three components: response initiation, response inhibition and consequence sensitivity. How these components differ from one another in terms of their use, behavioral theory and biological function is discussed, along with measurement techniques.

Dr. Schwartz, founder and editor in chief of Psychiatric Times, discusses his career as a clinician and entrepreneur.

Are juveniles mature enough to receive the death penalty? No, according to a ruling by the U.S. Supreme Court. Medical, psychiatric, psychological and brain-imaging data all supported the decision to ban execution of juvenile death-row inmates.

The FDA has issued a "black box" warning about the use of all antidepressants in the pediatric population due to a 1.8-fold increase in suicidality on drug compared to placebo. Yet these medications can be an effective tool in treating depression. How should parents and patients be educated, considering this information?

Autism is a highly prevalent, highly heterogeneous disorder of unknown etiology. Studies to clearly establish the efficacy of various classes of psychoactive drugs are scarce. Nonetheless, available findings do support the efficacy of atypical antipsychotics and antidepressants in treating the core symptoms of repetitive behavior.

Bipolar disorder in children is particularly difficult to treat. A treatment algorithm combining pharmacology with psychotherapy in order to get optimal results is presented.

The discipline of psychopharmacology has expanded enormously during the last several decades. As this Special Report illustrates, while the treatment of mental illness with medication has definitely advanced, it is neither quick nor easy. Instead, it has become more complex and complicated.

On March 31, Johnson & Johnson's Ortho-McNeil Neurologics unit added a warning to its prescribing label for galantamine hydrobromide, known commercially as Reminyl, a treatment approved for individuals who have mild to moderate Alzheimer disease (AD). On April 11, the company changed the commercial name of the drug to Razadyne.

Nerve root injections can help patients with lumbar radicular pain avoid surgery for at least 5 years, according to research from Washington University in St Louis that was presented in late February at the annual meeting of the American Academy of Orthopaedic Surgeons.

Mental illness occurs more frequently among people infected with HIV. In addition, individuals with mental illnesses are at greater risk for contracting HIV. Therefore, psychiatry has a great deal to offer in the management of patients with HIV--whether through proper patient education or safe and effective psychopharmacology.

Multiple studies show that diabetes approximately doubles the risk of comorbid depression. Furthermore, major depressive disorder is a risk factor for the subsequent development of type 2 diabetes mellitus. Treatments for depression in the setting of diabetes must be evaluated for their effects on blood glucose levels, propensity for weight gain, possible concomitant use for diabetic neuropathy and potential drug interactions.

Three recently published studies uncovered some answers to the genetic underpinnings of depression. Familial vulnerability was shown to increase with each generation affected by depression. Two genetic variants pointed in opposite directions: one showed an increase risk of depression and the other predicted responsiveness to antidepressants.

"No longer a pipe dream," is the suggestive lead-in of a widely distributed press release issued last October touting the potential benefits of cannabinoid compounds in the treatment of Parkinson disease (PD), Lou Gehrig disease-or amyotrophic lateral sclerosis (ALS)-and a number of other debilitating conditions, as reported during last fall's 2004 annual meeting of the Society for Neuroscience. According to Daniele Piomelli, PhD, an expert in cannabinoid research and professor in the Department of Pharmacology at the University of California, Irvine, certain cannabinoid compounds can be harnessed to "provide select benefits to patients while avoiding some of the unwanted effects" associated with marijuana use. Compounds of greatest interest have been WIN 55212-2, delta(9)-tetrahydrocannabinol (THC), and anandamide.

The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.

Although previous findings have suggested that certain gait impairments in patients with diabetes are specifically linked to neuropathy, researchers from Loma Linda University in California also have found gait abnormalities in patients with type 2 diabetes who did not have neuropathy.

It’s a classic risk/benefit dilemma: Does preventing suicidality-assuming suicidality can predict suicide-justify scaring some doctors away from prescribing antidepressants for young patients?

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