|
|
|
|
 |
Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
_______________________
PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
|
|
NeuroBiology of Trauma
Bipolar II Disorder
Title: Depression with DSM-IV atypical features: A marker for bipolar II disorder. Author(s): Benazzi, Franco Source: European Archives of Psychiatry & Clinical Neuroscience, Vol 250(1), 2000. pp. 53-55. Publisher: Germany: Springer Verlag Abstract: Examined the prevalence of atypical features in bipolar II depression versus unipolar depression and to find atypical features that could be a marker for bipolar II disorder. 557 unipolar and bipolar II depressed outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. DSM-IV atypical features were significantly more common in bipolar II patients than in unipolar patients. As the diagnosis of bipolar II disorder is often based on diagnosis of past hypomania, which may not be very reliable, depression with atypical features may point to bipolar II disorder diagnosis. _____
Title: Depressive mixed states: Unipolar and bipolar II. Author(s): Benazzi, F. Source: European Archives of Psychiatry & Clinical Neuroscience, Vol 250(5), 2000. pp. 249-253. Publisher: Germany: Springer Verlag Abstract: Investigated the prevalence of depressive mixed states (DMS) among depressed outpatients, the clinical differences between DMS and non-DMS, and relationships of DMS with unipolar and bipolar II. 98 Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) bipolar II and unipolar depressed outpatients were interviewed with the Structured Clinical Interview for DSM-IV. DMS was defined as a major depressive disorder with at least two concurrent hypomanic symptoms. DMS was present in 62.2 % of patients [48.7% of unipolar, 71.9% of bipolar II, (p = 0.022)]. DMS had significantly fewer unipolar, more bipolar II patients, lower age at onset and more atypical features than non-DMS. Bipolar II DMS had significantly more recurrences, more atypical features and lower age at onset (trend) than unipolar DMS. Bipolar II DMS had (trend) lower age at onset and more atypical features than bipolar II non-DMS. High DMS prevalence has important treatment implications, as antidepressants may worsen DMS, and some antidepressant-resistant depressions may be DMS responding to mood stabilizers. DMS may be distinct from non-DMS, but not from unipolar and bipolar II disorders, and this distinction may be due mainly to high bipolar II prevalence in DMS. _____
Title: Early- versus late-onset bipolar II disorder. Author(s): Benazzi, Franco, Morgagni Public Hosp, Dept of Psychiatry, Forli, Italy Source: Journal of Psychiatry & Neuroscience, Vol 25(1), Jan 2000. pp. 53-57. Publisher: Canada: Canadian Medical Assn Abstract: Compared the clinical features and the outcome between 179 outpatients (aged 16-75 yrs) with early- and late-onset bipolar II disorder presenting for treatment of a major depressive episode. Outcome measures included the duration of illness, severity of depression, recurrences, psychosis, chronicity, atypical features and comorbidity. Patients with early-onset (before 20, 25 or 30 years of age) bipolar II disorder had a significantly longer duration of illness and more recurrences compared with patients with late-onset (after 20, 25 or 30 years of age) bipolar II disorder. All other variables were not significantly different between the 2 groups. Indicators of worse outcome (severity of depression, psychosis, chronicity, comorbidity) were not significantly different between patients with early- and late-onset bipolar II disorder. _____
Title: Bipolar II and unipolar atypical depression. Author(s): Benazzi, Franco Source: Canadian Journal of Psychiatry, Vol 44(10), Dec 1999. pp. 1050-1051. Publisher: Canada: Canadian Psychiatric Assn Abstract: Aimed to find the prevalence of bipolar II disorder in atypical depression and to compare bipolar II with unipolar atypical depression, to determine if they are variants of the same disorder or distinct disorders. 100 patients presenting consecutively during 1998 for treatment of a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) major depressive episode with atypical features, occurring in major depression or unipolar and bipolar II disorders were included in the study. Patients were interviewed with the Structural Clinical Interview for DSM-IV Axis I Disorders--Clinician Version, Mood Disorder module, Montogmery Asberg Depression Rating Scale, and Global Assessment of Functioning Scale. Family members or close friends supplemented clinical information. Means and distributions of age at onset were not significantly different, supporting the hypothesis that bipolar II and unipolar atypical depression are variants of the same disorder. There were no significant differences in atypical features and other clinical features, supporting the similarity of the 2 disorders. _____
Title: Effectiveness of olanzapine treatment for severe obsessive-compulsive disorder. Author(s): Marazziti, Donatelia; Pallanti, Stefano Source: American Journal of Psychiatry, Vol 156(11), Nov 1999. pp. 1834-1835. Publisher: US: American Psychiatric Assn Abstract: Presents 2 cases of severe obsessive-compulsive disorder (OCD) in a male 21 yr old and female 29 yr old who dramatically improved after olanzapine was added to treatment with selective serotonin uptake inhibitors (sertraline and fluvoxamine, respectively). Significant improvements in OCD symptoms as measured by the Yale-Brown Obsessive Compulsive Scale scores were seen over 1-3 mos following initiation of treatment. Both Ss' mothers suffered from bipolar II disorder, which suggests that having a family history of bipolar disorder might predict a good response to olanzapine. _____
Title: Lithium versus carbamazepine in the maintenance treatment of bipolar II disorder and bipolar disorder not otherwise specified. Author(s): Greil, W., U Munich, Psychiatric Hosp, Munich, Germany; Kleindienst, N. Source: International Clinical Psychopharmacology, Vol 14(5), Sep 1999. pp. 283-285. Publisher: US: Lippincott Williams & Wilkins Abstract: Presents results regarding the comparative prophylactic efficacy of lithium and carbamazepine in 57 patients with a bipolar II or a bipolar disorder not otherwise specified (Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)). Results show that during the observation period of 2.5 yrs, no significant differences between the drugs were found considering hospitalization, recurrences, subclinical recurrences, concomitant medication and severe side effects. _____
Title: Bipolar II disorder and suicidal behavior. Author(s): Rihmer, Zoltan, National Inst for Psychiatry & Neurology, In- & Outpatient Dept of Psychiatry, No. XIII, Budapest, Hungary Pestality, Peter Source: Psychiatric Clinics of North America, Vol 22(3), Sep 1999. pp. 667-673. Publisher: United Kingdom: Elsevier Science Abstract: Despite the fact that the nosologic position of bipolar II disorder continues to be debated, several lines of research indicate that it is a distinct nosologic category that should be separated from both bipolar I and unipolar major depression. This review demonstrates that the lifetime risk of suicide attempts is highest in bipolar II and lowest in unipolar patients, whereas risk is intermediate in bipolar I patients. Moreover, 2 reports show that bipolar II patients are over represented among suicide victims. Clinicians must take great care in not missing this diagnosis, which, when untreated, has ominous prognostic implications. _____
Title: A comparison of the age of onset of bipolar I and bipolar II outpatients. Author(s): Benazzi, Franco Source: Journal of Affective Disorders, Vol 54(3), Aug 1999. pp. 249-253. Publisher: United Kingdom: Elsevier Science Abstract: Compared age at onset and indicators of severity (recurrences, chronicity, psychosis) between bipolar I and bipolar II disorders. 45 bipolar I and 141 bipolar II outpatients were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Age at onset distributions were compared with the Kolmogorov-Smirnov test. Results show that onset distributions were not significantly different between bipolar I and bipolar II patients. Severity was significantly higher in bipolar I patients. It is concluded that lack of significant difference in age at onset does not support the separation of the 2 disorders. Bipolar II disorder may be a less severe variant of bipolar disorder. _____
Title: The bipolar spectrum: A clinical reality in search of diagnostic criteria and an assessment methodology. Author(s): Cassano, Giovanni B., U Pisa, Dept of Psychiatry, Neurobiology, Pharmacology & Biotechnology, Pisa, Italy; Dell'Osso, Liliana; Frank, Ellen; Miniati, Mario; Fagiolini, Andrea; Shear, Katherine; Pini, Stefano; Maser, Jack Source: Journal of Affective Disorders, Vol 54(3), Aug 1999. pp. 319-328. Publisher: United Kingdom: Elsevier Science Abstract: Argues that although officially accepted in both International Classification of Diseases (ICD)--Revision 10 and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), the authors believe bipolar II disorder is underdiagnosed because of inattention to symptoms of hypomania. Moreover, by requiring the presence of both full-blown hypomanic and major depressive episodes, current nosology fails to include symptoms or signs which are mild and do not meet threshold criteria. There is already agreement in the field that such symptoms are important for depression. It is proposed that attention should also be devoted to mild symptomatic manifestations of a manic diathesis, even if such manifestations may sometimes enhance quality of life. The term "spectrum"" is used to refer to the broad range of such manifestations of a disorder from core symptoms to temperamental traits. Spectrum manifestations may be present during, between, or even in the absence of, an episode of full-blown disorder. A structured clinical interview to assess the mood spectrum (SCIMOODS) is proposed to evaluate the whole range of depressive and manic symptoms. This instrument is currently undergoing psychometric testing procedures. Similar to the SCID interview, the SCI-MOODS interview provides a separate rating for each of the major DSM-IV symptoms, but the latter also identifies and rates subthreshold and atypical manifestations. This paper presents the concept of a subthreshold bipolar disorder and discusses the potential epidemiological, diagnostic and therapeutic relevance of such a spectrum conditions. The SCI-MOODS interview used reliably to identify the occurrence of a bipolar spectrum condition are also described. _____
Title: Spectrum of activity of lamotrigine in treatment-refractory bipolar disorder. Author(s): Calabrese, Joseph R., Case Western Reserve Coll of Medicine, Mood Disorders Program, Cleveland, OH, US; Bowden, Charles L.; McElroy, Susan L.; Cookson, John; Andersen, John; Keck, Paul E.; Rhodes, Linda; Bolden-Watson, Carolyn; Zhou, Jing; Ascher, John A. Source: American Journal of Psychiatry, Vol 156(7), Jul 1999. pp. 1019-1023. Publisher: US: American Psychiatric Assn Abstract: This study was designed to provide preliminary evidence for the safety and efficacy of a new anticonvulsant, lamotrigine, in adult patients with bipolar disorder who had been inadequately responsive to or intolerant of prior pharmacotherapy. A 48-week, open-label, prospective trial was conducted in 75 patients with bipolar I or bipolar II disorder. Lamotrigine was used as adjunctive therapy (N=60) or monotherapy (N=15) in patients presenting in depressed, hypomanic, manic, or mixed states. Of the 40 depressed patients included in the efficacy analysis, 48% exhibited a marked response and 20% a moderate response as measured by reductions in 17-item Hamilton Depression Rating Scale scores. Of the 31 with a hypomanic, manic, or mixed state, 81% displayed a marked response and 3% a moderate response on the Mania Rating Scale. From baseline to endpoint, the depressed patients exhibited a 42% decrease in Hamilton depression scale scores, and the patients presenting with hypomania, mania, or a mixed state exhibited a 74% decrease in Mania Rating Scale scores. The most common drug-related adverse events were dizziness, tremor, somnolence, headache, nausea, and rash. Rash was the most common adverse event resulting in drug discontinuation (9% of patients). Conference: Annual Meeting of the American Psychiatric Association, 149th, May, 1996, NY, US Conference Notes: Also presented in part at the Annual Meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, Dec., 1996. _____
Title: Awareness of illness and subjective experience of cognitive complaints in patients with bipolar I and bipolar II disorders. Author(s): Pallanti, Stefano, Istituto di Neuroscience, Florence, Italy; Quercioli, Leonardo; Pazzagli, Adolfo; Rossi, Alessandro; Dell'Osso, Liliana; Pini, Stefano; Cassano, Giovanni Battista Source: American Journal of Psychiatry, Vol 156(7), Jul 1999. pp. 1094-1096. Publisher: US: American Psychiatric Assn Abstract: Investigated awareness of illness and subjective cognitive complaints of 57 outpatients (aged 24-47 yrs) with either bipolar I or bipolar II disorder during a phase of clinical stabilization. Ss were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) Axis I Disorders and completed measures including the Brief Psychiatric Rating Scale, the Hamilton Rating Scale for Depression, and the Social Adjustment Scale. Ss also completed the Frankfurt Complaints Questionnaire, to determine subjective cognitive complaint, and items from the Scale of Unawareness of Mental Disorder. Ss with bipolar II disorder had significantly less insight and a higher level of subjective complaints of stimulus overload than Ss with bipolar I disorder. Results suggest that a severe deficit in self-awareness may constitute a distinguishing psychopathological characteristic of patients with bipolar II disorder. Further studies are required to determine if there are associated neuropsychological dysfunctions. _____
Title: Ethnic differences in the presentation of bipolar affective disorder. Author(s): Kirov, G., U Wales, Coll of Medicine, Neuropsychiatric Genetics Unit, Cardiff, Wales; Murray, R. M. Source: European Psychiatry, Vol 14(4), Jul 1999. pp. 199-204. Publisher: France: Editions Scientifiques Elsevier Abstract: There have been repeated reports (e.g., G. Harrison et al, 1988) that Afro-Caribbean people living in the UK are more prone than white people to be diagnosed as having schizophrenia and mania, along with some evidence that they are less likely to receive a diagnosis of depression. This study attempted to replicate these findings in a population of patients on lithium prophylaxis. Clinical characteristics of 88 white British, 31 Afro-Caribbean and 15 African patients were assessed. 19 of the white patients met Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for unipolar depression and 8 met the criteria for bipolar II disorder (BP II); in contrast, only 2 black patients met the criteria for unipolar depression and none met the criteria for BP II. Among patients diagnosed as BP I, Africans were significantly more likely than whites to show exclusively or mainly manic presentations while Afro-Caribbeans were more likely to have had mood-incongruent delusions. White patients were significantly more likely than Afro-Caribbeans to have had suicidal ideas or actions. Findings could reflect either genuine ethnic differences in the presentation of severe affective disorder or be produced by the failure of British doctors to detect depression and deliver appropriate treatment to their black patients. _____
Title: Gabapentin-induced ejaculatory failure and anorgasmia. Author(s): Labbate, Lawrence A.; Rubey, Robert N. Source: American Journal of Psychiatry, Vol 156(6), Jun 1999. pp. 972. Publisher: US: American Psychiatric Assn Abstract: The authors report a case of ejaculatory failure and anorgasmia associated with gabapentin. Mr. A, a 41-yr-old man, had a long history of bipolar II disorder and alcohol dependence with intermittent cocaine abuse. Gabapentin treatment was initiated for the hypomania that he developed. While taking 300 mg of gabapentin 3 times per day, he noticed orgasm was more difficult to attain. Neither libido nor erection was affected. He could have intercourse with normal erection for 20 min but could not ejaculate. One week after stopping the gabapentin dose, he reported the return of his usual orgasm and ejaculation abilities. This case demonstrates a clear on/off phenomenon of anorgasmia related to gabapentin, which may be dose related. As gabapentin becomes more commonly used in psychiatric practice, the frequency of this adverse effect may become more apparent. _____
Title: Decision making in client-directed rehabilitation counseling: An Adlerian approach. Author(s): Bishop, Malachy, U Wisconsin, Dept of Rehabilitation Psychology, Madison, WI, US Source: Journal of Applied Rehabilitation Counseling, Vol 30(2), Sum 1999. pp. 32-37. Publisher: US: NRCA Abstract: Presents an assessment technique for helping clients to develop vocational goals within a framework congruent with client-directed rehabilitation. The assessment utilizes the Adlerian constructs of lifestyle and life tasks to help the client and counselor work together to develop successful rehabilitation plans. A case study of a 48-yr-old woman diagnosed with Bipolar II Disorder is included to demonstrate how such an assessment helps in goal development and maximizes client involvement in decision making. _____
Title: Lithium-treated mood disorders, paroxysmal rhinorrhea, and mesial temporal lobe epilepsy. Author(s): Berner, Jon Source: Journal of Neuropsychiatry & Clinical Neurosciences, Vol 11(3), Sum 1999. pp. 414-415. Publisher: US: American Psychiatric Assn Abstract: Reports the cases of 2 patients with carbamazepine-responsive mood disorders, 1 a 48-yr-old female with rapid-cycling bipolar II disorder and the other a 38-yr-old male prison inmate with chronic depression. The patients' mood disorders are inferred to be secondary to mesial temporal lobe epilepsy. Paroxysmal rhinorrhea, exacerbated or invoked by lithium use, is prominent in the clinical history. _____
Title: Prevalence and clinical features of atypical depression in depressed outpatients: A 467-case study. Author(s): Benazzi, Franco, Public Hosp "Morgagni", Dept of Psychiatry, Forli, Italy Source: Psychiatry Research, Vol 86(3), Jun 1999. pp. 259-265. Publisher: United Kingdom: Elsevier Science Abstract: Investigated the prevalence of Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) atypical depression and differences between atypical and non-atypical depression in 467 unipolar and bipolar depressed outpatients in private practice. Consecutive outpatients presenting for treatment of a major depressive episode were assessed with the Comprehensive Assessment of Symptoms and History following DSM-IV criteria (N. C. Andreasen et al; 1992), the Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. The prevalence of atypical depression was 38.1%. Of the variables investigated (unipolar and bipolar diagnoses, age at onset, gender, psychosis, comorbidity, chronicity, duration of illness, recurrences, and severity), age at onset was significantly lower, and female gender, comorbidity, and bipolar II disorder were significantly more common in atypical than nonatypical depression. Comparisons between bipolar II atypical depression and unipolar atypical depression did not show significant differences, apart from age at onset. Findings suggest that there are important clinical differences between atypical and non-atypical depression in private practice outpatients. _____
Title: Lamotrigine for the treatment of bipolar disorder: A clinical case series. Author(s): Suppes, Trisha, U Texas, Southwestern Medical Ctr, Dallas, TX, US; Brown, E. Sherwood; McElroy, Susan L.; Keck, Paul E. Jr.; Nolen, Willem; Kupka, Ralph; Frye, Mark; Denicoff, Kirk D.; Altshuler, Lori; Leverich, Gabrielle S.; Post, Robert M. Source: Journal of Affective Disorders, Vol 53(1), Apr 1999. pp. 95-98. Publisher: United Kingdom: Elsevier Science Abstract: Early reports in epilepsy studies suggested mood-related effects of lamotrigine treatment, as have preliminary reports in bipolar patients. 17 patients (aged 35-59 yrs) meeting Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for bipolar I or bipolar II disorder displaying affective symptoms and a past history of inadequate response or tolerability to at least 2 standard mood stabilizing agents were treated with the new anticonvulsant lamotrigine in an add-on, open-label study. Response to therapy was assessed using the Clinical Global Impression Scale modified for bipolar disorder. 11 patients (65%) were rated as very much or much improved. Lamotrigine was well tolerated, and may have mood stabilizing and antidepressant properties in some patients with bipolar disorder. _____
Title: Personality disorders in bipolar II patients. Author(s): Vieta, Eduard, U Barcelona, Hosp Clinic, Dept of Psychiatry, Bipolar Disorders Program, Barcelona, Spain; Colom, Francesc; Martinez-Aran, Anabel; Benabarre, Antonio; Gasto, Cristobal Source: Journal of Nervous & Mental Disease, Vol 187(4), Apr 1999. pp. 245-248. Publisher: US: Lippincott Williams & Wilkins Abstract: In an attempt to ascertain the influence of personality disorders (PD) comorbidity in several clinical and course variables of bipolar II patients, the authors studied a sample of these patients and compared those with a comorbid diagnosis of any personality disorder with those with "pure" bipolar II disorder. Patients were diagnosed and several clinical variables were obtained from the structured interviews with the patient and at least one first-degree relative or partner. The bipolar II sample was split according to the presence of DSM-IV PD, resulting in one group of 27 patients without PD and another group of 13 with a PD, which were compared. When bipolar II patients with and without PD were compared, there were no significant differences between them with respect to demographic data. However, patients with a comorbid PD had an earlier age of onset of the affective disorder than "pure" bipolar II and a higher rate of suicidal ideation. _____
Title: Possible gabapentin-induced thyroiditis. Author(s): Frye, Mark A., U California, Psychiatric Inst, Los Angeles, CA, US; Luckenbaugh, Dave; Kimbrell, Tim A.; Constantino, Cassandra; Grothe, Dale; Cora-Locatelli, Gabriela; Ketter, Terence A. Source: Journal of Clinical Psychopharmacology, Vol 19(1), Feb 1999. pp. 94-95. Publisher: US: Lippincott Williams & Wilkins Abstract: Presents the case of a possible association between gabapentin and thyroiditis. The patient, a 28-yr-old nonsmoking female with rapid cycling bipolar II disorder, had a medical history notable for atypical tuberculosis, epiglottis, and right frontal head trauma without loss of consciousness as a child. Over a course of 5 mo, the S participated in a randomized, double-blind, crossover trial of gabapentin monotherapy vs lamotrigine monotherapy vs placebo. After this study period, she began a blinded combination phase of both anticonvulsants. Thyroid function was assessed twice monthly. Her baseline thyroid function was normal, as was her serum thyroglobulin level. During the midphase of gabapentin, 3,600 mg/day, she was noted to be only mildly depressed. However, over the next several weeks during which she received a higher dose of gabapentin (4,800 mg), she developed mild physical symptoms of hyperthyroidism. Mood instability was also present. Her vital signs were stable, and physical examination findings were negative for exophthalmus, enlarged thyroid gland, or hyperreflexia. Upon gabapentin discontinuation there was prompt resolution of symptoms and a return to baseline thyroid function. Thus, a provisional diagnosis of a gabapentin-induced thyroiditis was made. _____
Title: Prevalence of bipolar II disorder in atypical depression. Author(s): Benazzi, Franco Source: European Archives of Psychiatry & Clinical Neuroscience, Vol 249(2), 1999. pp. 62-65. Publisher: Germany: Springer Verlag Abstract: The aim of the present study was to find the prevalence of bipolar II disorder among Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) atypical depression outpatients. Bipolar II and unipolar atypical depressions were also compared to find if they were variants of the same disorder or if instead they were different disorders. 140 consecutive unipolar outpatients (mean age 44.5 yrs at baseline) and bipolar II outpatients (mean age 36.7 yrs at baseline), presenting for treatment of an atypical major depressive episode, were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning Scale. The prevalence of bipolar II disorder was 64.2%. The age at baseline and onset were significantly lower in bipolar II vs unipolar patients. All the other variables (MADRS items, duration of illness, severity, gender, psychosis, comorbidity, chronicity, recurrences) were not significantly different. The prevalence of bipolar II disorder among atypical depressed outpatients was higher than previously reported. _____
Title: Depressive comorbidity of panic, social phobic, and obsessiive-compulsive disorders re-examined: Is there a bipolar II connection? Author(s): Perugi, Giulio, U Pisa, Inst of Psychiatry, Pisa, Italy; Akiskal, Hagop S.; Ramacciotti, Sandra; Nassini, Stefano; Toni, Cristina; Milanfranchi, Alessandro; Musetti, Laura Source: Journal of Psychiatric Research, Vol 33(1), Jan-Feb 1999. pp. 53-61. Publisher: United Kingdom: Elsevier Science Abstract: Utilizing the %DSM-III-R% schema, we have investigated lifetime comorbidity between panic disorder with or without agoraphobia (PD), social phobia (SP) and obsessive-compulsive disorder (OCD) on the one hand, and mood disorder on the other. Compared with PD, the results for SP and OCD showed significantly higher numbers of comorbid anxiety and mood disorders. In addition, SP and OCD were significantly more likely to concur with each other than with PD. The complexity of these comorbid patterns is underscored by the finding of significantly higher numbers of anxiety disorders in those with lifetime comorbidity with bipolar (especially bipolar II) disorder. We conclude that the comorbidity between anxiety and mood disorders--conventionally conceived as the relationship between anxiety and unipolar depressive states--might very well extend into the domain of bipolar spectrum disorders in a subset of these disorders. _____
Title: Bipolar II depressed outpatients are frequent: A 423-case study. Author(s): Benazzi, Franco Source: Canadian Journal of Psychiatry, Vol 43(9), Nov 1998. pp. 954. Publisher: Canada: Canadian Psychiatric Assn Abstract: Sought to find the proportion of persons with bipolar II disorder among outpatients with a major depressive episode who had been diagnosed with a major depressive, bipolar I, or bipolar II disorder. 423 consecutive major depressive, bipolar I, and bipolar II disorder outpatients presenting for treatment of a major depressive episode to a private practice were interviewed. Bipolar II disorder was present in 44.9% of patients, bipolar I disorder in 4%, and major depressive disorder in 51%. Results suggest that bipolar II disorder is common among unipolar and bipolar outpatients with a major depressive episode. _____
Title: Algorithms for dsm-iv psychiatric diagnoses using the fh-rdc in a community sample. Author(s): Farwell, Dianna, U South Carolina, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(5-B), Nov 1998. pp. 2151. Publisher: US: Univ Microfilms International Abstract: Objectives. This study used the Family History-Research Diagnostic Criteria (FH-RDC) in a population of late adolescents to: (1) develop algorithms for constructing diagnoses for 25 disorders in the FH-RDC using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), (2) compare diagnoses in older adolescents as determined by the FH-RDC and K-SADS-P and (3) compare the weighted prevalence estimates of disorders for the community sample of 4,113 students and their relatives to the lifetime prevalence estimates reported in the DSM-IV. Methods. Data were obtained from a second wave of a longitudinal study of major depressive disorder in a community sample of adolescents (Garrison et al., 1991, 1992). Algorithm development was completed by comparing the FH-RDC to the diagnostic criteria in the DSM-IV. The Kappa statistic compared the agreement of diagnoses in older adolescents as determined by the FH-RDC algorithms with the K-SADS-P diagnoses when both interview schedules were completed by the same informant (n = 364). Prevalence estimates for the community sample using the FH-RDC algorithms were compared to lifetime prevalence estimates in the DSM-IV. Results. No cases of bulimia, obsessive compulsive disorder, panic with agoraphobia and schizophrenia were identified using either the FH-RDC or the K-SADS-P. Dysthymia, bipolar I disorder, bipolar II disorder, generalized anxiety disorder, anorexia and schizoaffective disorder indicated no agreement above chance. Remaining Kappas ranged from 0.09 for phobias to 0.41 for conduct disorder showing poor agreement above chance. In the community sample anorexia was the only disorder to fall within the range of reported prevalence estimates for females in the DSM-IV. Conclusions. This is the first study to compare the K-SADS-P to the FH-RDC. The results were similar to other studies that compared the FH-RDC to the SADS-L. Overall, results indicated lower prevalence estimates from the FH-RDC than those reported in the DSM-IV. The results suggest revisions to the FH-RDC to enhance the quality of data collected for adults, and to develop a child and adolescent version of the FH-RDC. _____
Title: Failure to demonstrate parent-of-origin effect in transmission of bipolar II disorder. Author(s): Kato, Tadafumi, U Tokyo, Faculty of Medicine, Dept of Psychiatry, Tokyo, Japan; Winokur, George; Coryell, William; Rice, John; Endicott, Jean; Keller, Martin B.; Akiskal, Hagop S. Source: Journal of Affective Disorders, Vol 50(2-3), Sep 1998. Special issue: George Winokur. pp. 135-141. Publisher: United Kingdom: Elsevier Science Abstract: Parent-of-origin effect (POE) is suggested in transmission of bipolar disorder. To investigate POE in bipolar II disorder (BPII), the gender difference of transmitting parents, prevalence rate in children, and age at onset of patients in relation to the sex of the transmitting parent, were examined in 220 BPII patients (mean age 31.4 yrs). No evidence suggesting involvement of POE was found. It is concluded that POE is not involved in transmission of BPII and that female BPII patients do not transmit the disease more often than male patients. _____
Title: The emerging epidemiology of hypomania and bipolar II disorder. Author(s): Angst, Jules, Zurich U Psychiatric Hosp, Zurich, Switzerland Source: Journal of Affective Disorders, Vol 50(2-3), Sep 1998. Special issue: George Winokur. pp. 143-151. Publisher: United Kingdom: Elsevier Science Abstract: The literature on the lifetime prevalence of the bipolar spectrum suggests rates of 3-6.5%. When the Zurich cohort study retrospectively applied the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for hypomania, a prevalence rate up to age 35 of 5.5% of hypomania/mania and a further 2.8% for brief hypomania (recurrent and lasting 1-3 days) was identified. The validity of DSM-IV hypomania and brief hypomania was demonstrated by a family history of mood disorders, a history of suicide attempts and treatment for depression. Comorbidity with anxiety disorders and substance abuse was found equally in both subtypes of hypomania. The study suggests that recurrent brief hypomania belongs to the bipolar spectrum. The findings should be verified on larger national cohorts in other epidemiological and clinical studies. _____
Title: Systematic clinical methodology for validating bipolar-II disorder: Data in mid-stream from a French national multi-site study (EPIDEP). Author(s): Hantouche, Elie G., U Paris VI, Hopital Pitie-Salpetriere, Paris, France; Akiskal, Hagop S.; Lancrenon, Sylvie; Allilaire, Jean-Francois; Sechter, Daniel; Azorin, Jean-Michel; Bourgeois, Marc; Fraud, Jean-Philippe; Chatenet-Duchene, Liliane Source: Journal of Affective Disorders, Vol 50(2-3), Sep 1998. Special issue: George Winokur. pp. 163-173. Publisher: United Kingdom: Elsevier Science Abstract: Presents the methodology and clinical data in mid-stream from a French multi-center study (EPIDEP) in progress on a national sample of patients with Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) major depressive episode (MDE). The aim of EPIDEP is to assist practising psychiatrists to recognize bipolarity in all of its varieties, especially psychotic mixed mania, and bipolar II (BP-II) forms. EPIDEP involves training 48 French psychiatrists in 15 regions. Results are presented on 250 (of the 537) MDE patients studied thus far during the acute phase. 88% of cases assigned to cyclothymic temperament by clinicians were recognized as BP-II. Cyclothymia and hypomania were correlated significantly. With a systematic search for hypomania, 40% of major depressive episodes were classified as BP-II, of which only half were known to physicians at study entry. Cyclothymic temperamental dysregulation emerged as a robust clinical marker of BP-II disorder. Data indicate that clinicians in diverse practice settings can be trained to recognize soft bipolarity leading to changes in diagnostic practice at a national level. _____
Title: The high prevalence of bipolar II and associated cyclothymic and hyperthymic temperaments in HIV-patients. Author(s): Perretta, P., VA Psychiatry Service, San Diego, CA, US; Akiskal, Hagop S.; Nisita, C.; Lorenzetti, C.; Zaccagnini, E.; Della Santa, M.; Cassano, G. B. Source: Journal of Affective Disorders , Vol 50(2-3), Sep 1998. Special issue: George Winokur. pp. 215-224. Publisher: United Kingdom: Elsevier Science Abstract: Compared 46 HIV patients (aged 23-66 yrs) with index major depressive episode (MDE) to an equal number of age- and sex-matched seronegative MDE patients, and systematically examined rates of Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) bipolar subtypes (enriched in accordance with H. S. Akiskal's (1983) system of classifying soft bipolar disorders). Although HIV and psychiatric clinic patients had comparable background in terms of familial affective loading, HIV patients had significantly higher familial rates for alcohol and substance use. The more important finding was the significantly higher proportion of HIV patients with lifetime bipolar II disorder (78%), and associated cyclothymic (52%) and hyperthymic (35%) temperaments; the findings were the same irrespective of HIV risk status (intravenous drug user vs homosexual and other risk groups combined). _____
Title: Bipolar disorders in DSM-IV: Impact of inclusion of rapid cycling as a course modifier. Author(s): Dunner, David L., U Washington, Dept of Psychiatry & Behavioral Sciences, Seattle, WA, US Source: Neuropsychopharmacology, Vol 19(3), Sep 1998. pp. 189-193. Publisher: United Kingdom: Nature Publishing Abstract: In this paper, we review the process for inclusion of rapid cycling as a course modifier to bipolar disorders in Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). This process involved definition of bipolar II disorder, delineating the duration of manic episode for bipolar I disorder, and clarification of the diagnosis of cyclothymic disorder and mixed mania. _____
Title: Does sleep EEG data distinguish between UP, BPI, BPII major depressions? An age and gender controlled study. Author(s): Fossion, P., U Hosp Brugmann, Inst of Psychiatry & Medical Psychology, Brussels, Belgium; Staner, L.; Dramaix, M.; Kempenaers, Ch.; Kerkhofs, M.; Hubain, Ph.; Verbanck, P.; Mendelwicz, J.; Linkowski, P. Source: Journal of Affective Disorders, Vol 49(3), Jun 1998. pp. 181-187. Publisher: United Kingdom: Elsevier Science Abstract: Clinical characteristics and sleep EEG data of 9 male and 5 female unipolar, 9 male and 5 female bipolar I and 9 male and 5 female bipolar II patients, matched for age, were investigated during a major depressive episode. There was similarity in the clinical characteristics of the 3 samples and, concerning EEG data, a trend to a higher percentage of awakening among bipolar I patients. Pairwise comparisons of the 3 subgroups showed that only the Newcastle rating scale score reaches significant difference between bipolar I and bipolar II groups, and between bipolar I and unipolar groups, difference of percentage of REM sleep between bipolar I and bipolar II groups, and differences of sleep period time between bipolar II and unipolar groups. The distribution of REM latencies in the bipolar I subgroup was different from the 2 others. _____
Title: Lithium maintenance treatment of depression and mania in bipolar I and bipolar II disorders. Author(s): Tondo, Leonardo, McLean Hosp, Mailman Research Ctr, Belmont, MA, US; Baldessarini, Ross J.; Hennen, John; Floris, Gianfranco Source: American Journal of Psychiatry, Vol 155(5), May 1998. pp. 638-645. Publisher: US: American Psychiatric Assn Abstract: Compared the effects of long-term lithium (Li) treatment for depressive and manic phases of type I and type II bipolar disorders. Clinical research records of 317 adult patients with bipolar disorder (188 with type I and 129 with type II) were analyzed for frequency and duration of affective episodes and hospitalizations before vs during Li maintenance treatment. Bipolar I and bipolar II Ss were ill before treatment a similar percentage of time, but the subtype distinction was supported descriptively. Li had superior benefits in type II Ss, with significantly greater reduction of episodes per year and of the percentage of time ill. Reduction of depressive morbidity was similarly strong in both diagnostic types. During treatment, bipolar II Ss had 5.9-fold longer interepisode intervals and were twice as likely as type I Ss to have no new episodes. Starting Li maintenance earlier predicted greater improvement. Overall, Li maintenance yielded striking long-term reductions of depressive as well as manic morbidity in both bipolar disorder subtypes, with greater overall benefits in type II patients and with earlier treatment. _____
Title: Abnormal facial emotion recognition in depression: Serial testing in an ultra-rapid-cycling patient. Author(s): George, Mark S., Medical U of South Carolina, Dept of Radiology, Functional Neuroimaging Div, Charleston, SC, US; Huggins, Teresa; McDermut, Wilson; Parekh, Priti I.; Rubinow, David; Post, Robert M. Source: Behavior Modification, Vol 22(2), Apr 1998. Special issue: Facial expressions of emotions. pp. 192-204. Publisher: US: Sage Publications Abstract: It is suggested that normal subjects use the right insula and bilateral anterior temporal and prefrontal cortices to recognize the emotion expressed in a human face. Mood disorder subjects have a selective deficit in recognizing human facial emotion. Brain imaging studies show that they fail to activate the right insula to the same degree as controls, even when accurately assessing facial emotion. Many issues remain, however, including whether the facial emotion recognition errors in mood disorder subjects are state dependent or persist during normal mood states (and, thus, reflect a trait abnormality). To probe this issue, the authors repeatedly studied a 40-yr-old male bipolar II patient's ability to recognize faces' emotional content. This patient made significantly more errors in facial emotion recognition during the depressed state. He also demonstrated a significant negative bias when he was depressed compared with nondepressed states. It is suggested that this case study demonstrates the state dependency of the defect in human facial emotion recognition. _____
Title: Episodic course in obsessive-compulsive disorder. Author(s): Perugi, Giulio, U Pisa, Dept of Psychiatry, Pisa, Italy; Akiskal, Hagop S.; Gemignani, Alfredo; Pfanner, Chiara; Presta, Silvio; Milanfranchi, Alessandro; Lensi, Patrizia; Ravagli, Susanna; Maremmani, Icro; Cassano, Giovanni B. Source: European Archives of Psychiatry & Clinical Neuroscience, Vol 248(5), 1998. pp. 240-244. Publisher: Germany: Springer Verlag Abstract: The course of obsessive-compulsive disorder (OCD) is variable, ranging from episodic to chronic. The authors hypothesized that the former course is more likely to be related to bipolar mood disorders. With the use of a specially constructed OCD questionnaire, 135 patients fulfilling Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for OCD, with an illness duration of at least 10 yrs, were studied and divided by course: 27.4% were episodic and 72.6% chronic. The authors compared clinical and familial characteristics and comorbidity. Episodic OCD had a significantly lower rate of checking rituals and a significantly higher rate of a positive family history for mood disorder. Multivariate stepwise discriminant analysis revealed a positive and significant relationship between episodic course, family history for mood disorders, lifetime comorbidity for panic and bipolar-II disorders, late age at onset and negative correlation with generalized anxiety disorder. These data suggest that the episodic course of OCD has important clinical correlates which are related to cyclic mood disorders. This correlation has implications for treatment and research strategies on the etiology within a subpopulation of OCD. _____
Title: Diagnostic revisions for DSM-IV. Author(s): Dunner, David L., U Washington, Medical Ctr, Dept of Psychiatry, Seattle, WA, US Source: Mania: Clinical and research perspectives. Goodnick, Paul J. (Ed); pp. 3-10. Washington, DC, US: American Psychiatric Association, 1998. xxiv, 412 pp. Abstract: (from the chapter) In this chapter the author reviews the diagnostic revisions proposed for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) in the area of bipolar mood disorders. The major proposals include establishment of duration criteria for manic episodes of bipolar I disorder, separation of bipolar II from bipolar I and disorders not otherwise specified (NOS), and adding rapid cycling as a parenthetical modifier to bipolar I and bipolar II disorders. Truncated rapid cycling is subsumed in cyclothymic disorder. One area that still requires further research is the definition of bipolar mixed. There is a small but growing database reflecting its differentiation from other more typical manic syndromes. _____
Title: Antidepressant-associated hypomania in outpatient depression: A 203-case study in private practice. Author(s): Benazzi, F., Public Hosp Morgagni, Dept of Psychiatry, Forli, Italy Source: Journal of Affective Disorders, Vol 46(1), Oct 1997. pp. 73-77. Publisher: United Kingdom: Elsevier Science Abstract: Studied the incidence of hypomania/mania in 203 consecutive mood disorder outpatients, treated with antidepressants in private practice, during a follow-up of 3 to 6 mo. Of these, 50.7% were unipolar, 45.3% were bipolar II, and 3.9% were bipolar I patients. Interviews were conducted with the Comprehensive Assessment of Symptoms and History to make diagnoses using Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. The Montgomery and Asberg Depression Rating Scale and the Global Assessment of Functioning Scale were used to assess depression severity at baseline. Compared to unipolar patients, bipolar II patients had a threefold greater risk of switching , but a lower rate than expected from previous work. In a previous analysis of the whole sample, bipolar II patients had a lower age at onset and more frequent atypical features than unipolar patients. Both unipolar and bipolar switchers had instead early age at onset and frequent atypical features, suggesting that these factors might increase the risk of switching in unipolar depression. _____
Title: Psychosensory symptoms in bipolar disorder. Author(s): Ali, S. Omar, National Inst of Mental Health, Biological Psychiatry Branch, Section on Psychobiology, Bethesda, MD, US; Denicoff, Kirk D.; Ketter, Terence A.; Smith-Jackson, Earlian E.; Post, Robert M. Source: Neuropsychiatry, Neuropsychology, & Behavioral Neurology, Vol 10(4), Oct 1997. pp. 223-231. Publisher: US: Lippincott Williams & Wilkins Abstract: Investigated psychosensory symptoms and their relationship to retrospective and prospective courses of illness, as well as therapeutic outcomes, in patients with bipolar disorder. Using the Silberman-Post Psychosensory Rating Scale (SP-PSRS), psychosensory symptoms were assessed in 51 patients (aged 19-74 yrs) who met Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for bipolar disorder and in 39 healthy, normal controls. Psychosensory scores from patients with bipolar disorder were compared with scores from healthy controls and with a variety of retrospective and prospective course of illness and treatment variables. Psychosensory symptoms occurred frequently in patients with bipolar I and II disorders, but were rare in controls. When depressed, patients with bipolar II disorder reported more psychosensory symptoms when compared to patients with bipolar I disorder, and those with a history of rapid cycling reported more psychosensory symptoms when compared to patients without a history of rapid cycling. Although the presence of psychosensory symptoms is associated with some bipolar subtypes (patients with bipolar IT disorder and patients with a history of rapid cycling), they do not appear to predict treatment response. _____
Title: Dysthymia and cyclothymia: Historical origins and contemporary development. Author(s): Brieger, Peter, Martin Luther U, Psychiatric Hosp, Halle-Wittenberg, Germany; Marneros, Andreas Source: Journal of Affective Disorders, Vol 45(3), Sep 1997. pp. 117-126. Publisher: United Kingdom: Elsevier Science Abstract: Reviews data, methodologies, and concepts concerning subaffective disorders (dysthymia and cyclothymia) and puts them in historical context. The historic roots of dysthymic and cyclothymic disorders are essentially Greek, but the 1st use of the word dysthymia in psychiatry was by C. F. Flemming in 1844. E. Hecker introduced the term cyclothymia in 1877. K. L. Kahlbaum (1882) further developed the concepts of hyperthymia, cyclothymia and dysthymia--with possible subthreshold symptomatology--in 1882. After Kraepelin's rubric of manic-depressive insanity, the term dysthymia was widely forgotten, and cyclothymia became ill defined. Today the latter term is used in 3, partially contradictory, senses: (1) a synonym for bipolar disorder, (2) a temperament and (3) a subaffective disorder. A renaissance of subaffective disorders began with the development of Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III). Therapeutically important research has focused on dysthymic disorder and its relationship to major depressive disorder, while cyclothymic disorder is relatively neglected; nonetheless, operationalized as a subaffective dimension or temperament, cyclothymia appears to be a likely precursor or ingredient of the construct of bipolar II disorder. _____
Title: High intracellular calcium concentrations in transformed lymphoblasts from subjects with bipolar I disorder. Author(s): Emamghoreishi, Masoumeh; Schlichter, Lyanne; Li, Peter P.; Parikh, Sagar Source: American Journal of Psychiatry, Vol 154(7), Jul 1997. pp. 976-982. Publisher: US: American Psychiatric Assn Abstract: Examined whether intracellular Ca-2+ abnormalities are trait related. Basal Ca-2+ concentration was measured by using ratiometric fluorescence assay with fura-2 for T lymphocytes and Epstein-Barr-virus-immortalized B lymphoblasts from physically healthy Ss with Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnoses of bipolar mood disorder (bipolar I, N = 28; bipolar II, N = 11) or major depressive disorder (N = 14), mixed psychiatric patients with nonmood disorders (N = 14), and 20 healthy Ss. Phytohemagglutinin-stimulated (10 Rg/ml) intracellular Ca-2+ levels were also determined in T lymphocytes. The basal Ca-2+ concentration was significantly higher in the B lymphoblasts from patients with bipolar I disorder, but not bipolar II disorder or major depression, than in healthy Ss or psychiatric patients with nonmood disorders. Contrasts of diagnoses within gender revealed significantly higher basal Ca-2+ concentrations in T lymphocytes in male bipolar I patients. Phytohemagglutinin-stimulated Ca-2+ concentrations did not differ among groups, but the percent differences from basal Ca-2+ levels were lower in bipolar I and depressed Ss than in healthy Ss. _____
Title: Suicidal behavior in bipolar I and bipolar II disorder. Author(s): Vieta, Eduard, U Barcelona, Hosp Clinic de Barcelona, Dept of Psychiatry & Clinical Psychology, Barcelona, Spain; Benabarre, Antoni; Colom, Francesc; Gasto, Cristobal; et al. Source: Journal of Nervous & Mental Disease, Vol 185(6), Jun 1997. pp. 407-408. Publisher: US: Lippincott Williams & Wilkins Abstract: Examined the clinical characteristics of 22 bipolar II vs 38 classic bipolar I patients (all aged 18-65 yrs), with special reference to suicidal behavior. Ss were assessed using the Schedule for Affective Disorders and Schizophrenia. Results show that although clinical differences differ between bipolar I and II patients, rates of noncompleted suicidal behavior are similar in both groups. _____
Title: Trastorno bipolar II: Curso y conducta suicida. Translated Title: Bipolar II disorder: Course and suicidal behavior. Author(s): Vieta, E., Hospital Clinic, Subdivision de Psiquiatria y Psicologia Clinica, Barcelona, Spain; Colom, F.; Gasto, C.; Nieto, E.; Benabarre, A.; Otero, A. Source: Actas Espanolas de Psiquiatria, Vol 25(3), May-Jun 1997. pp. 147-151. Publisher: Spain: Editorial Garsi SA Abstract: 22 patients with bipolar II disorder and 38 patients with bipolar I disorder were evaluated with the Schedule for Affective Disorders and Schizophrenia by 2 independent interviewers. Bipolar II Ss had significantly more previous episodes, including both depressive and hypomanic switches, but had been hospitalized and presented psychotic symptoms less frequently. There were no significant differences between both groups regarding suicidal behavior variables. Results suggest that bipolar II disorder is less severe than bipolar I regarding symptoms intensity, but more severe with respect to episodes frequency, and that suicide attempts rates are not useful to discriminate between the 2 groups. _____
Title: Effectiveness of restarting lithium treatment after its discontinuation in bipolar I and bipolar II disorders. Author(s): Tondo, Leonardo, Harvard Medical School, Dept of Psychiatry & Neuroscience Program, Boston, MA, US; Baldessarini, Ross J.; Floris, Gianfranco; Rudas, Nereide Source: American Journal of Psychiatry, Vol 154(4), Apr 1997. pp. 548-550. Publisher: US: American Psychiatric Assn Abstract: Tested the hypothesis that resumption of lithium treatment of bipolar disorders may be less effective after maintenance treatment has been discontinued. 86 patients with type I or II bipolar disorder, not selected according to response to treatment, were followed prospectively during 2 periods of lithium maintenance treatment averaging 4.6 and 4.4 yrs. Morbidity (illness episodes per year, hospitalizations per year, percentage of time ill) was assessed, and use of adjunctive medication was rated. Morbidity was similar in the 1st and 2nd treatment periods, with no differences in numbers of manic and depressive episodes or differences by gender, diagnostic type, length of 1st treatment, interval between treatments, or discontinuation rate. There was 12.8% more use of adjunctive medication in the 2nd period. _____
Title: Prevalence of bipolar II disorder in outpatient depression: A 203-case study in private practice. Author(s): Benazzi, Franco, Public Hosp "Morgagni", Dept of Psychiatry, Forli, Italy Source: Journal of Affective Disorders, Vol 43(2), Apr 1997. pp. 163-166. Publisher: United Kingdom: Elsevier Science Abstract: The aim of this study was to find the prevalence of bipolar II disorder in 203 consecutive individuals presenting with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) major depressive episode, and to look for differences between bipolar II disorder and unipolar depression. It was carried out in a private psychiatric setting, because it is more representative of the population with affective disorders who seek psychiatric help in Italy. The interview assessing major psychoses and affective disorders was conducted with the Comprehensive Assessment of Symptoms and History. The Montgomery and Asberg Depression Rating Scale and the Global Assessment of Functioning Scale were used to assess depression severity. Results indicated 45% of Ss had bipolar II disorder, 51% had unipolar depression, and 4% had bipolar I disorder. The observed prevalence of bipolar II disorder was higher than previously reported in clinical samples. Bipolar II disorder had age at baseline and onset lower than unipolar depression, and more atypical features. Other variables (baseline depression severity, number of depressive episodes, psychosis, chronicity, comorbidity) were similar, suggesting that the depressive phase of bipolar II disorder differs only in 1, but important, dimension (atypical features) from unipolar depression. _____
Title: Differential features between bipolar I and bipolar II disorder. Author(s): Vieta, E., Hospital Clinic, Dept of Psychiatry, Barcelona, Spain; Gasto, C.; Otero, A.; Nieto, E. Source: Comprehensive Psychiatry, Vol 38(2), Mar-Apr 1997. pp. 98-101. Publisher: United Kingdom: Elsevier Science Abstract: Although bipolar II disorder is generally viewed as a mild form of classic manic-depressive illness, recent investigations suggest that it could be a valid diagnostic category different from bipolar I in genetic, biological, clinical, and pharmacological aspects. 22 patients fulfilling Research Diagnostic Criteria (RDC) for the diagnosis of bipolar II disorder and 38 bipolar I patients were evaluated with the Schedule for Affective Disorders and Schizophrenia by 2 independent interviewers and compared. All Ss were aged 18-65 yrs. Bipolar II patients had significantly more previous episodes, including both depressive and hypomanic switches, but had been hospitalized and presented psychotic symptoms less frequently. These results suggest that bipolar II disorder is less severe than bipolar I with regard to symptom intensity, but is more severe with respect to episode frequency. _____
Title: On the nature of depressive and anxious states in a family practice setting: The high prevalence of bipolar II and related disorders in a cohort followed longitudinally. Author(s): Manning, J. Sloan, U Tennessee, Dept of Family Medicine, Memphis, US; Haykal, Radwan F.; Connor, Pamela D.; Akiskal, Hagop S. Source: Comprehensive Psychiatry, Vol 38(2), Mar-Apr 1997. pp. 102-108. Publisher: United Kingdom: Elsevier Science Abstract: Much of the scientific literature on affective states in primary care settings is derived from instrument-based diagnoses, typically without the benefit of clinical in-depth examination. In a naturalistic family practice setting, this study prospectively evaluated 108 consecutive anxious and/or depressed patients. All diagnoses derived from semistructured interviews conducted by a family physician with enhanced training in mood disorders. Nonbipolar depressions were found in 60 of 108 patients, nearly half of whom were in the depression not otherwise specified (DNOS) category; yet on careful history, all but 2 of 28 DNOS cases had major depressive episodes in the past. 28 patients were diagnosed with bipolar I, II, or III disorder or cyclothymia. Panic disorder was found in 9%, and obsessive-compulsive disorder and active chemical dependency were each diagnosed in 3%. Bipolar spectrum disorders were common and at times were not recognized until several weeks or months into the treatment phase of the depressed or anxious state. Although the largest percentage of patients had DNOS at the index episode, bipolar illness was also common. Findings contrast with the nearly total unipolarity reported in the instrument-based (nonclinician) literature. _____
Title: Comparative antidepressant effects of intravenous and intrathecal thyrotropin-releasing hormone: Confounding effects of tolerance and implications for therapeutics. Author(s): Callahan, Ann M., Bronx Veterans Affairs Medical Ctr, Bronx, NY, US; Frye, Mark A.; Marangell, Lauren B.; George, Mark S.; et al. Source: Biological Psychiatry, Vol 41(3), Feb 1997. pp. 264-272. Publisher: United Kingdom: Elsevier Science Abstract: Described the acute antidepressant effects of intrathecal and iv thyrotropin (or thyroid) releasing hormone (TRH) administered in a double-blind design to 2 treatment-refractory depressed inpatients with bipolar II disorder, and their subsequent clinical courses during an open therapeutic trial of repeated iv or subcutaneous/ly (sc) TRH. Ss were a 50-yr-old married white female and a 53-yr-old married white male. Results showed that each S experienced a robust antidepressant response by both routes; subsequent open trials of iv TRH also were effective until apparent tolerance developed. Intrathecal TRH was readministered and both Ss again experienced robust antidepressant responses. These findings suggest a differential mechanism of tolerance to the 2 routes of administration and raise the possibility that a subgroup of patients may be responsive to the antidepressant effects of TRH independent of its route of administration. _____
Title: Mood disorders. Author(s): Essau, Cecilia Ahmoi, U Bremen, Klinische Psychologie, Bremen, Germany; Petermann, Ulrike Source: Developmental psychopathology: Epidemiology, diagnostics and treatment. Essau, Cecilia Ahmoi (Ed); Petermann, Franz (Ed); pp. 265-310. Amsterdam, Netherlands: Harwood Academic Publishers, 1997. xvii, 478 pp. Abstract: (from the chapter) Discusses the following topics as they pertain to children and adolescents: definition and classification (major depressive disorder, dysthymic disorder, bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other mood disorders), risk factors (sociodemographic, biological, family and psychological, and social factors), comorbidity, long-term course and outcome (age of onset, duration of episodes, relapse, psychosocial impairment, health service utilization, and assessment), and treatment (pharmacotherapy, psychological interventions, and preventive programs). _____
Title: Premorbid personality in patients with uni- and bipolar affective disorders and controls: Assessment by the Biographical Personality Interview (BPI). Author(s): Hecht, Heidemarie, U Freiburg, Dept of Psychiatry & Psychotherapy, Germany; van Calker, Dietrich; Spraul, Gebhard; Bohus, Martin Source: European Archives of Psychiatry & Clinical Neuroscience, Vol 247(1), 1997. pp. 23-30. Publisher: Germany: Springer Verlag Abstract: The relationship between premorbid personality and subtypes of affective disorder was investigated by means of the Biographical Personality Interview (BPI) and by a self-rating scale. Interviewer and rater (BPI) were blind to diagnosis. A total of 52 patients with unipolar depression or bipolar II disorder (D/Dm), 32 bipolar-I patients (DM) and 39 control Ss (C) were examined. Expert rating of "typus melancholicus" features (BPI) were found to be more pronounced in D/Dm than in DM and C. "Typus manicus" features were also distinguished between both clinical groups, whereas anxious-insecure features were not significantly different between the groups of patients. In contrast to the expert-rated personality variants, self-rating of personality features did not reveal any significant differences between the 2 clinical groups. Potential sources of the discrepancies between the questionnaire data and the interview data are discussed. It is concluded that premorbid features of "typus manicus" and "typus melancholicus" predicted, respectively, a predominant manic and a predominant depressive course of an affective disorder. _____
Title: Bipolar II disorder. Author(s): Fawcett, Jan, Rush-Presbyterian-St. Luke's Medical Ctr, Dept of Psychiatry, Chicago, IL, US Source: Psychiatric Annals, Vol 26(7, Suppl), Jul 1996. pp. S440-S443. Publisher: US: SLACK Abstract: Discusses issues related to bipolar II disorder diagnostic categories. Topics include (1) whether bipolar II is distinct from either unipolar or bipolar I depression disorder; (2) whether bipolar II's true prevalence is greater than initially presumed; (3) to what extent bipolar II overlaps other diagnoses, such as Axis II personality disorders or substance abuse disorders; and (4) the debate over the most effective pharmacologic management of bipolar II. _____
Title: Inositol-induced mania? Author(s): Levine, Joseph; Witztum, Eliezer; Greenberg, Ben D.; Barak, Yoram Source: American Journal of Psychiatry, Vol 153(6), Jun 1996. pp. 839. Publisher: US: American Psychiatric Assn Abstract: Reports the cases of a 24-yr-old man and a 31-yr-old woman with recurrent major depression and a 37-yr-old man with bipolar II disorder, all of whom developed possible inositol-induced mania or hypomania. Because in all 3 cases other antidepressants were used in combination, it is possible that mania or hypomania were induced through other antidepressant mechanisms. Further investigation of inositol, with its potentially novel mechanism of action, seems warranted. _____
Title: Bupropion and nightmares. Author(s): Balon, Richard Source: American Journal of Psychiatry, Vol 153(4), Apr 1996. pp. 579-580. Publisher: US: American Psychiatric Assn Abstract: Describes the case of a 55-yr-old White woman who suffered from bipolar II disorder. She was treated with a regimen of bupropion. The S began to experience nightmares 4 days after the bupropion dose was increased to 150 mg/day. The S's dose was decreased to 75 mg/day of bupropion but the nightmares continued. The S also experienced cold sweats and anxiety and anger upon awakening from a nightmare. When the S stopped bupropion treatment, her sleep improved, and her nightmares gradually ceased. _____
Title: Clinical features of mania in adulthood. Author(s): Keck, Paul E. Jr., U Cincinnati, Coll of Medicine, Dept of Psychiatry, Biological Psychiatry Program, Cincinnati, OH, US; McElroy, Susan L.; Kmetz, Geri F.; Sax, Kenji W. Source: Mood disorders across the life span. Shulman, Kenneth I. (Ed); Tohen, Mauricio (Ed); et al; pp. 265-279. New York, NY, US: Wiley-Liss, 1996. xv, 442 pp. Abstract: (from the chapter) the presentation of mania in adults includes symptoms affecting mood, behavior and activity, and cognition and perception / evolving nosologies of manic-depressive illness have gradually recognized that different mixtures of symptoms across these 3 domains of human functioning may occur, accounting for manic, mixed, and depressive mood episodes; that bipolar disorder is a recurrent illness and that the frequency of these recurrences may culminate in rapid cycling; that hypomania is a distinct presentation of bipolar illness, may be more common than mania, and corresponds to the diagnosis of bipolar II disorder / these changes in the classification of the type and severity of mood episode and frequency of recurrence have been incorporated in Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and have important treatment and prognostic implications
|
