History Of Bipolar Disorder Research Articles

Bupropion SR for smoking cessation

Cigarette dependence is recognised as a life-threatening disorder which can be treated by behavioural support and/or medication. Bupropion hydrochloride sustained-release (Zyban™, GlaxoSmithKline) is licensed in many countries including the US, Canada, UK, Australia and continental Europe to aid smoking cessation. The usual recommended dose is 150 mg b.i.d. taken for 7 – 14 days prior to the quit date, and then 6 – 8 weeks afterwards (figures vary across countries). Evidence from seven double-blind, placebo-controlled, randomised trials shows that it improves success at staying off cigarettes for at least 12 months by 9 – 10 percentage points. Taking into account estimates of subsequent cessation and relapse patterns in treated and untreated smokers, and the improvement in life-expectancy of smokers who manage to stop, the estimated cost/life/year saved from an episode of use of the medication is ∼ UK£1000 or US$1500. Bupropion has CNS stimulant properties; the common side effects are dry mouth and sleep disturbance. Rare but serious side effects are anaphylactic/hypersensitivity reaction and seizure (both estimated at 1 in a 1000). The drug is contraindicated in patients with hypersensitivity to the drug or its metabolites, any seizure disorder, eating disorder, severe hepatic cirrhosis, history of bipolar disorder or in patients taking monoamine oxidase inhibitors. Extreme caution is advised where there are any predisposing factors that may reduce the seizure threshold. Bupropion sustained-release and nicotine replacement therapies are both considered as first-line treatments to aid smoking cessation. Ideally patients should also enrol in a structured behavioural support programme to boost their chances of success.

Fluoxetine response in children with autistic spectrum disorders: correlation with familial major affective disorder and intellectual achievement.

One hundred and twenty-nine children, 2 to 8 years old, with idiopathic autistic spectrum disorder diagnosed by standard instruments (Childhood Austim Ratings Scale and Autism Diagnostic Observation Schedule) were treated with fluoxetine (0.15 to 0.5mg/kg) for 5 to 76 months (mean 32 to 36 months), with discontinuation trials. Response criteria are described. Family histories were obtained using the family history method in repeated interviews. Fluoxetine response, family history of major affective disorder, and unusual intellectual achievement, pretreatment language, and hyperlexia were used to define a coherent subgroup of autistic spectrum disorder. Statistical analyses were post hoc. Of the children, 22 (17%) had an excellent response, 67 (52%) good, and 40 (31%) fair/poor. Treatment age did not correlate with response. Fluoxetine response correlated robustly with familial major affective disorder and unusual intellectual achievement, and with hyperlexia in the child. Family history of bipolar disorder and of unusual intellectual achievement correlated strongly. Five children developed bipolar disorder during follow-up. Fluoxetine response, family history of major affective disorder (especially bipolar), unusual achievement, and hyperlexia in the children appear to define a homogeneous autistic subgroup. Bipolar disorder, unusual intellectual achievement, and autistic spectrum disorders cluster strongly in families and may share genetic determinants.

Status Epilepticus After Massive Carbamazepine Overdose

We report two patients who experienced status epilepticus after carbamazepine overdose. The first patient was an 18-year-old female with a history of epilepsy. She experienced 4 hour of persistent and prolonged seizures resistant to sodium amytal therapy. The status epilepticus ended with her death. The second patient was an 18-year-old male with a history of bipolar disorder. He experienced 5 hour of persistent and prolonged seizures that appeared to be resistant to diazepam, phenytoin, and phenobarbital. The seizures abated with the infusion of midazolam. This is a report of status epilepticus associated with wide complex tachycardia after carbamazepine overdose, which may be resistant to conventional therapy.

Acute granulomatous interstitial nephritis and colitis in anticonvulsant hypersensitivity syndrome associated with lamotrigine treatment

We present the case of a 17-year-old woman with a history of bipolar disorder, who developed a clinical syndrome manifested by fever, lymphadenopathy, skin rash, diarrhea, and acute renal failure requiring dialysis after the use of lamotrigine. Renal biopsy showed acute interstitial nephritis (AIN) with focal granulomas. Similarly, colonic biopsy specimens showed colitis and ileitis with non-necrotizing epithelioid granulomas. The patient had a complete recovery after withdrawal of the medication and steroid treatment. Although lamotrigine has been previously implicated in the development of anticonvulsant hypersensitivity syndrome, there have been no previous reports of acute granulomatous interstitial nephritis or colitis associated with the use of this drug.

Antidepressants plus cognitive therapy reduced relapse in residual depression

(1999) Arch Gen Psychiatry 56, 829. Paykel ES, Scott J, Teasdale JD, et al. . Prevention of relapse in residual depression by cognitive therapy. A controlled trial. . Sep; ....

Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder.

The relationship between attention deficit hyperactivity disorder (ADHD) and earlier age at onset of affective illness was examined in probands with a history of bipolar disorder. The authors assessed 56 adult bipolar subjects. Those with a history of childhood ADHD (N=8) were age and sex matched with bipolar subjects without a history of childhood ADHD (N=8). The age at onset of the first affective episode was lower for the subjects with bipolar disorder and a history of childhood ADHD (mean=12.1 years, SD=4.6) than for those without a history of childhood ADHD (mean=20. 0 years, SD=11.3). ADHD in children of bipolar probands might identify children at highest risk for development of bipolar disorder.

Comorbidity of ADHD with Bipolar Disorder

The age at onset of affective illness in 56 adults with a history of bipolar disorder was studied in relation to attention deficit hyperactivity disorder (ADHD) in childhood, at the Massachusetts General Hospital, Boston, MA.

My role as a consumer-provider: challenges and opportunities.

In this first-person account, Edward G. Francell, Jr., MSW, discusses his history of bipolar disorder and panic disorder with agoraphobia, and how his experience helps him help others.

Lithium Therapy: Limitations and Alternatives in the Treatment of Bipolar Disorders

As clinical experience with lithium treatment of bipolar disorders accumulates, factors predictive of nonresponse are emerging. Prominent among these are conditions such as comorbid substance abuse and the presence of the malignant variants rapid cycling and mixed states. Lithium therapy is further complicated by noncompliance, attributable in large measure to burdensome side effects such as memory impairment and cognitive slowing. The issues of lithium nonresponse and noncompliance have driven the search for alternative agents, such as the anticonvulsants carbamazepine and valproic acid. While preliminary evidence suggests that these agents may provide improvements over lithium in terms of tolerability and response (especially in rapid cycling and mixed states), methodologic limitations temper the conclusiveness of these findings. The natural history of bipolar disorders is defined by characteristic symptom clusters which evolve in intensity and duration over long time scales, resulting in a high morbidity and mortality. These features raise critical concerns for research design, especially concerning the ethics of placebo controls and the need to generate long-term observational data upon which to predicate meaningful treatment recommendations. With the apparent increase in lithium nonresponse in recent years, the need to identify and definitively evaluate alternative agents is becoming imperative.

Schizophrenics with a family history of bipolar disorder. Possible involvement of obstetric complications

SummaryThe case reports of two DSM III-R schizophrenic patients with a family history of bipolar disorder are presented. The two patients had a history of severe obstetric complications (OCs). These cases are discussed in the light of neurodevelopmental theories of schizophrenia and in the continuum view of psychosis.