Bipolar Disorder And Medications

What is Biploar Disorder?
Bipolar or manic depressive illness is a brain disorder that causes a typical changes in mood, energy and activity levels. Bipolar 1 disorder is diagnosed as having manic or mixed episodes, which are not normal of the person's behaviour. The episodes last for at least a week and require medical attention. The person also experiences depressive episodes, which last approximately two weeks. In between the cycling of manic and depression, many can live normal lives. Symptoms first appear in teens or early 20s, with many developing the disorder before the age of 50.

Bipolar Disorder Medications
Many different medications are needed for the best course of treatment as patients respond to the drugs differently. The medication should be taken continuously for the prevention of a relapse. Manic episodes in bipolar I disorder require treatment with drugs, such as antidepressants, mood stabilizers, benzodiazepines, and newer antipyschotics.

To track and treat the illness, the patient carries out a daily life chart of their mood symptoms, treatments, sleeping patterns and life events. Usually, the first choice of treatment is the long term use of mood stabilisers. With the exception of lithium, they are anticonvulsants to treat seizures as well as controlling mood. There are many types of mood stabilisers on the market. Lithium was the first to be approved by the U.S. Food and Drug Administration (FDA). It is frequently effective in controlling the symptoms of mania, and preventing the recurrence of manic and depressive episodes.

Valproic acid is as effective as lithium for treating mania. Lamotrigine is the more recent for maintaining the treatment. Less prescribed anticonvulsants include gabapentin, topiramate and oxcarbazepine as they are not more effective than the mood stabilisers. It is thought that by taking valproic acid, lamotrigine and other anticonvulsants, it increases the risk of suicidal thoughts and behaviours and therefore patients are closely monitored.

In addition to the disorder, patients often have problems with their thyroid gland. The overproduction or underproduction of the thyroid hormone can lead to mood and energy changes. It has been seen that hypothyroidism is associated with the rapid cycling of the bipolar disorder, occurring especially in women.

Atypical antipsychotic drugs are often used for treatment. They are usually taken with other drugs. These include: olanzapine, which is given with an antidepressant to help relieve symptoms of severe mania or psychosis. It can also be given intravenously to treat agitation of manic or mixed episodes. Aripiprazole has the same effect as olanzapine as well maintaining treatment after a severe or sudden episode. Quetiapine relieves the symptoms of severe and sudden manic episodes. Risperidone and ziprasidone are also prescribed for controlling manic or mixed episodes.

Other treatments include:
Psychotherapy to educate, support and provide guidance to people with the disorder and their families. A study carried out by NIMH had found that patients that were treated with medication and extensive psychotherapy, underwent fewer relapses, fewer admissions to hospitals, and were able to stick to treatment plans.

Electroconvulsive therapy is used to treat severely depressive, manic or mixed episodes. It is not usually given as a first line of treatment.

View the original article here ezine.com

We Are Not Manic We Have Bipolar Disorder

The stigma for a mental illness is enormous and even in this era of modern technology it still haunts the mentally ill. Bipolar carries a nasty stigma with it because of its former name, manic depression. Mania definitely sounds crazy even too me, and I don't know if bipolar depression will ever be just bipolar illness as long as mania stays in its definition.

I have yet to figure out why they don't define bipolar 1 sufferers as experiencing periods of extreme highs which is often seen as doing things on impulse without thinking of consequences, like overspending, unsafe and excessive sex, chemicals, gambling, quitting a job suddenly, and saying unkind things with no regret. A bipolar 1 has extreme highs which are usually brief but very intense and depressive lows which can last for weeks and months or they cycle very rapidly as in days or hours. Bipolar 2 sufferers experience a very deep depression which is often misidentified as major depression but bipolar 2 depression is extremely low when compared to when their mood is elevated.

The elevated mood is often seen as their functioning level instead of a slightly elevated from normal. Someone with bipolar 2 may not even realize their mood is elevated slightly more than normal The depression can be so devastating you can't even get out of bed, and the hopelessness and helplessness make you wonder if life is really worth all of this mental pain.. Bipolar disorder also affects, memory, concentration, appetite, sleep patterns, and self-esteem. Additionally, bipolar disorder has been linked to anxiety and health problems such as diabetes, heart disease, migraines, and high blood pressure. It really is not known for sure if any of these affects are caused by the medications we are prescribed or if it is coincidental.

Some bipolar sufferers figure out how to live very normal lives. Others like myself have learned to live makeshift normal lives in that we live as normal of a life as we are able to but still need disability. Then there are those who are desperately searching for a way to manage their illness. This is very positive believe it or not if they're able to hang in their long enough to find medications, skills or both to manage their illness. They'll have a great chance at a normal life. Lastly you have those who like the highs so much they don't want to do anything about their illness and for those my thoughts are with you especially when you hit the lows and start coming back up.

Bipolar sufferers knows that it isn't the extreme depression that will kill you because you don't have enough energy to take your life. But, it is when you start coming back out of the depths that you are able to find the energy to kill yourself. Regardless of how you choose to treat your bipolar the word mania or manic doesn't need to be in the definition or descriptions of what bipolar sufferers experience. Let's get them removed.

Nowhere in my definition do you find mania or manic it isn't necessary. It's time to rally together and get manic and mania eliminated from the definition of bipolar 1 and 2. We really are not crazy, just people who have a mental illness which can be managed whether by medication, therapy or self awareness.

Patty Hauer
http://iambipolar2.net/
Diagnosed with bipolar 1993

View the original article here ezine.com

New research might help people suffering from post-traumatic stress disorder

ScienceDaily (Aug. 2, 2011) — The discovery of a mechanism in the brain explains for the first time why people make particularly strong, long-lasting memories of stressful events in their lives and could help sufferers of post-traumatic stress disorder.

The study, carried out by researchers from the University of Bristol's Henry Wellcome Laboratories for Integrative Neuroscience & Endocrinology (HW-LINE) in the School of Clinical Sciences, and funded by the Biotechnology and Biological Sciences Research Council (BBSRC), is published online this week in the Proceedings of the National Academy of Sciences (PNAS).

The research found that stress hormones directly stimulate biochemical processes in neurons that play a role in learning and memory. The way these hormones stimulate these signalling and epigenetic processes in neurons is completely new and has never been shown before.

In the healthy brain these processes operate smoothly and help people to cope with and learn from stressful events in their lives. In vulnerable people or in strongly traumatized people (victims of rape or war), these processes may be disturbed and stressful events may result in the formation of highly traumatic memories such as those seen in patients suffering from post-traumatic stress disorder (PTSD). The discovery may lead to new ways to develop drugs to help these patients and to prevent PTSD in trauma victims.

Professor Johannes Reul, Professorial Research Fellow in Neuroscience at HW-LINE, said: "Making memories of events in our lives is of critical importance in order to cope properly with new situations and challenges in the future. This is of particular importance for emotional and traumatic life events. Our newly discovered mechanism should be regarded as an adaptive mechanism. We believe this mechanism could be disturbed in stress-related psychiatric disorders such as depression and anxiety.

"The new findings may be of particular significance for patients suffering from post-traumatic stress disorder (PTSD) as these patients are pained by pathological memories of an endured trauma (rape or war situations). We hope our discovery may help to generate a new class of drugs to help these patients."

The researchers found that stress-induced glucocorticoid hormones enhance memory formation through a direct, physical interaction of glucocorticoid-binding receptors ("glucocorticoid receptor") with a particular intracellular signalling pathway in a specific population of neurons of the hippocampus. This signalling pathway, the so-called ERK MAPK pathway, is known to be strongly involved in learning and memory processes but it was not known that it could interact with glucocorticoid receptors and that this would lead to an enhancement of memory formation.

This type of interaction has never been described before. The interaction has a major impact as the stimulated signalling cascade results in augmented epigenetic mechanisms in the nucleus of the affected neurons leading to enhanced expression of certain gene products. The induced gene products are known to evoke structural and functional changes in neurons allowing them to strengthen their role in the memory circuits of the brain.

It is well known that people make very strong memories of stressful, emotionally disturbing events in their lives. These so-called episodic memories are memories of the place (e.g. room, office) or surroundings where the event happened, how we felt at the time (mood), and the time of the day at which it happened. These kind of memories can last a lifetime.

The consolidation of such memories is taking place in a specific limbic brain region called the hippocampus -- part of the brain involved in memory and learning. Hormones secreted during stress like the glucocorticoid hormone cortisol (in rodents, corticosterone) act on the hippocampus to enhance the consolidation of these memories. However, until now it has been unknown how these hormones act on the hippocampus to enhance the formation of emotional event-related memories.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Bristol.

Journal Reference:

María Gutièrrez-Mecinas, Alexandra F. Trollope, Andrew Collins, Hazel Morfett, Shirley A. Hesketh, Flavie Kersanté, and Johannes M. H. M. Reul. Long-lasting behavioral responses to stress involve a direct interaction of glucocorticoid receptors with ERK1/2–MSK1–Elk-1 signaling. Proceedings of the National Academy of Sciences, August 1, 2011 DOI: 10.1073/pnas.1104383108

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Persons displaced by war at increased risk of posttraumatic stress disorder, depression, anxiety

ScienceDaily (Aug. 3, 2011) — Residents of Sri Lanka who were internally displaced during the civil conflict that occurred in their country from 1983 to 2009 have a higher prevalence of war-related mental health conditions that include depression, anxiety and posttraumatic stress disorder, according to a study in the August 3 issue of JAMA, a theme issue on violence and human rights.

Armed conflicts may result in displacement of persons seeking refuge in neighboring countries or secure areas of their own country (internal displacement). "Nearly 2.7 million individuals worldwide are internally displaced annually by armed conflict. The Sri Lankan conflict resulted in approximately 100,000 deaths and displacement of 800,000 people during the 26-year war," according to background information in the article. In the Jaffna District of Sri Lanka, a peninsula in the far north of the country, it has been estimated that 23 percent of the population had been internally displaced by July 2009. "Although overall patterns of psychiatric morbidity among conflict-affected populations have been documented, less is known about the psychological effect of forced displacement among individuals who remain within their national borders."

Farah Husain, D.M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a health survey among residents of Jaffna District to assess the association between displacement status and the prevalence of common war-related mental health conditions. The survey was conducted between July and September 2009 among 1,517 Jaffna District households, including 2 internally displaced persons camps. The response rate was 92 percent (1,448 respondents, 1,409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5 percent (n = 539) were recently resettled, and 68.5 percent (n = 790) were long-term residents. A total of 376 (31.8 percent) participants experienced no trauma events; 578 (44.0 percent) reported experiencing 1 to 4 events; 336 (20.2 percent) experienced 5 to 9 events; and 72 (4.0 percent) experienced 10 or more events.

The overall prevalences of posttraumatic stress disorder (PTSD), anxiety, and depression symptoms were 7.0 percent, 32.6 percent, and 22.2 percent, respectively. After adjusting for variables, the researchers found that the odds of having symptoms of depression, anxiety, and PTSD were significantly higher among displaced camp-based individuals compared with long-term residents and that the odds of reporting PTSD symptoms among recently resettled participants was higher than that of long-term residents. Female respondents were more likely to report symptoms of anxiety and depression. Older age was associated with PTSD, anxiety, and depression symptoms. The authors also found that displacement was no longer associated with mental health symptoms after controlling for trauma exposure.

"Although the association between displacement status and symptoms of PTSD, depression, and anxiety was no longer significant after adjusting for trauma exposure in this study, the act of being displaced and the daily stressors associated with it may be considered traumatic in themselves and may be an indicator or proxy for recent trauma as well. Therefore, the relationship between displacement status and mental health symptoms may be driven by the underlying trauma events displaced persons have experienced, events that likely caused them to leave their homes," they write.

The researchers suggest that interventions in Sri Lanka should target the most vulnerable populations, especially those living in displacement camps. "Internally displaced persons outnumber refugees globally and initiatives addressing mental health needs, such as those developed by the Inter-Agency Standing Committee, should be considered. In Jaffna District, interventions should include support from family, friends, religious leaders, and traditional counselors. Finally, a longitudinal study of displaced populations would help determine how the intensity of events, the time since events, and other factors, such as coping skills, affect mental health symptoms. In this way, stakeholders could begin to understand the short- and long-term mental health implications of armed conflict and traumatic events associated with displacement."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

F. Husain, M. Anderson, B. Lopes Cardozo, K. Becknell, C. Blanton, D. Araki, E. Kottegoda Vithana. Prevalence of War-Related Mental Health Conditions and Association With Displacement Status in Postwar Jaffna District, Sri Lanka. JAMA: The Journal of the American Medical Association, 2011; 306 (5): 522 DOI: 10.1001/jama.2011.1052

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

New research might help people suffering from post-traumatic stress disorder

ScienceDaily (Aug. 2, 2011) — The discovery of a mechanism in the brain explains for the first time why people make particularly strong, long-lasting memories of stressful events in their lives and could help sufferers of post-traumatic stress disorder.

The study, carried out by researchers from the University of Bristol's Henry Wellcome Laboratories for Integrative Neuroscience & Endocrinology (HW-LINE) in the School of Clinical Sciences, and funded by the Biotechnology and Biological Sciences Research Council (BBSRC), is published online this week in the Proceedings of the National Academy of Sciences (PNAS).

The research found that stress hormones directly stimulate biochemical processes in neurons that play a role in learning and memory. The way these hormones stimulate these signalling and epigenetic processes in neurons is completely new and has never been shown before.

In the healthy brain these processes operate smoothly and help people to cope with and learn from stressful events in their lives. In vulnerable people or in strongly traumatized people (victims of rape or war), these processes may be disturbed and stressful events may result in the formation of highly traumatic memories such as those seen in patients suffering from post-traumatic stress disorder (PTSD). The discovery may lead to new ways to develop drugs to help these patients and to prevent PTSD in trauma victims.

Professor Johannes Reul, Professorial Research Fellow in Neuroscience at HW-LINE, said: "Making memories of events in our lives is of critical importance in order to cope properly with new situations and challenges in the future. This is of particular importance for emotional and traumatic life events. Our newly discovered mechanism should be regarded as an adaptive mechanism. We believe this mechanism could be disturbed in stress-related psychiatric disorders such as depression and anxiety.

"The new findings may be of particular significance for patients suffering from post-traumatic stress disorder (PTSD) as these patients are pained by pathological memories of an endured trauma (rape or war situations). We hope our discovery may help to generate a new class of drugs to help these patients."

The researchers found that stress-induced glucocorticoid hormones enhance memory formation through a direct, physical interaction of glucocorticoid-binding receptors ("glucocorticoid receptor") with a particular intracellular signalling pathway in a specific population of neurons of the hippocampus. This signalling pathway, the so-called ERK MAPK pathway, is known to be strongly involved in learning and memory processes but it was not known that it could interact with glucocorticoid receptors and that this would lead to an enhancement of memory formation.

This type of interaction has never been described before. The interaction has a major impact as the stimulated signalling cascade results in augmented epigenetic mechanisms in the nucleus of the affected neurons leading to enhanced expression of certain gene products. The induced gene products are known to evoke structural and functional changes in neurons allowing them to strengthen their role in the memory circuits of the brain.

It is well known that people make very strong memories of stressful, emotionally disturbing events in their lives. These so-called episodic memories are memories of the place (e.g. room, office) or surroundings where the event happened, how we felt at the time (mood), and the time of the day at which it happened. These kind of memories can last a lifetime.

The consolidation of such memories is taking place in a specific limbic brain region called the hippocampus -- part of the brain involved in memory and learning. Hormones secreted during stress like the glucocorticoid hormone cortisol (in rodents, corticosterone) act on the hippocampus to enhance the consolidation of these memories. However, until now it has been unknown how these hormones act on the hippocampus to enhance the formation of emotional event-related memories.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Bristol.

Journal Reference:

María Gutièrrez-Mecinas, Alexandra F. Trollope, Andrew Collins, Hazel Morfett, Shirley A. Hesketh, Flavie Kersanté, and Johannes M. H. M. Reul. Long-lasting behavioral responses to stress involve a direct interaction of glucocorticoid receptors with ERK1/2–MSK1–Elk-1 signaling. Proceedings of the National Academy of Sciences, August 1, 2011 DOI: 10.1073/pnas.1104383108

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

REM sleep behavior disorder is a risk factor for Parkinson's disease

ScienceDaily (July 29, 2011) — Patients suffering REM sleep behaviour disorders dream nightmares in which they are attacked and pursued, with the particularity that they express them by screaming, crying, punching and kicking while sleeping. Lancet Neurology has published the third consecutive work in five years about the relationship between this disorder and Parkinson's disease.

The first work showed in 2006 that 45% of patients who suffer this sleep disorder develop Parkinson's disease and other neurodegenerative diseases caused by a lack of dopamine in the brain. The second article discovered that neuroimaging tests that measure dopamine in the brain, such as the brain SPECT, are useful to identify patients with REM sleep disorders with increased risk of developing a neurodegenerative diseases such as Parkinson's disease.

The new study applied brain SPECT to conclude that the levels of dopamine in the brain are quickly lowering over the years in patients with REM sleep behaviour disorder. This neuroimaging technique becomes the first tool to detect the disease progression at an early stage. The first author of the three articles is Dr. Àlex Iranzo, doctor from the Neurology Service at the Hospital Clínic of Barcelona, researcher at the Biomedical Research Institute of August Pi i Sunyer (IDIBAPS) and member of the Multidisciplinary Sleep Disorders Unit , and the senior authors were to Dr. Joan Santamaria and Dr. Eduard Tolosa, from the same institution.

The study involved comparing for three years the evolution of brain SPECT in 20 patients with REM disorder and 20 healthy controls. The neuroimaging technique measures the presence of dopamine in the substantia nigra, a part of the brain associated with learning and harmony of body movements. In Parkinson's disease a deficiency of dopamine in the substantia nigra causes tremor, stiffness and movement slowness in patients. Results show that after 3 years of monitoring the production of dopamine in the control group was reduced by 8% due to age, while the group of REM sleep disorder patients experienced a reduction of 20%. Once the 3 year follow-up ended, 3 of 20 patients in the REM sleep disorder group had developed Parkinson's disease and their dopamine reduction was around 30%.

The three works led by the IDIBAPS -- Hospital Clínic of Barcelona team conclude that more efforts are needed to create neuroprotective drugs that prevent the progression from REM sleep behavior disorders to Parkinson's disease. For the first time scientists have a technique, brain SPECT, to evaluate whether these drugs are effective. Authors of the study suggest that, to be considered effective, a neuroprotective drug should significantly prevent the dopamine concentration from dropping in these patients.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Can feeling too good be bad? Positive emotion in bipolar disorder

ScienceDaily (July 22, 2011) — Positive emotions like joy and compassion are good for your mental and physical health, and help foster creativity and friendship. But people with bipolar disorder seem to have too much of a good thing. In a new article to be published in the August issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science, psychologist June Gruber of Yale University considers how positive emotion may become negative in bipolar disorder.

One of the characteristics of bipolar disorder is the extreme periods of positive mood, or mania. People in the grip of mania also have increased energy, sleep less, and experience extreme self-confidence. At first glance, this may sound good and even desirable. However, during these times of mania, people with bipolar disorder often take dangerous risks, run up their credit card debt, and wreak havoc in marriages. "The fact that positive emotion has gone awry is something unique about bipolar disorder, as almost all other emotional disorders are characterized by difficulties in negative emotions" Gruber says.

Gruber points out that positive emotions are problematic for people with bipolar disorder even when they're not experiencing mania. Gruber has studied people whose bipolar disorder is in remission and found that they still experience more positive emotions than people who have never had bipolar disorder. More positive emotions may not sound like a bad thing, but there are times when these positive emotions aren't appropriate. "In our work, those with bipolar disorder continue to report greater positive emotions whether it's a positive film, very sad film clip of a child crying over his father's death, and even disgusting films involving someone digging through feces" she says. In more recent work Gruber and her colleagues have found they still feel good even if a close romantic partner tells them something sad face to face, they still feel good. "It's rose-colored glasses gone too far."

Clinical psychologists may also be able to use this research to figure out who with bipolar disorder is likely to relapse; people who have a lot of positive emotions, even at inappropriate times, may provide a window into possible early warning signs, Gruber says. In a study of healthy college students who had never been diagnosed with bipolar disorder, Gruber found that those who showed these same high levels of positive emotions that persisted across positive, negative and neutral situations were at higher risk for bipolar disorder.

But not all emotions are alike in bipolar disorder; in fact, they seem to have particular kinds of positive emotions. They report feeling more achievement and self-focused emotions like pride and rewarding feelings like joy. They don't differ social emotions that connect us with others, like love and compassion. "This mirrors early clinical observations and more recent scientific work," Gruber says -- that people with bipolar disorder set very high, ambitious goals, are sensitive to rewards, and in periods of mania, some believe they have special powers.

Psychologists should also consider that there are downsides of positive emotions even for people who don't have bipolar disorder, Gruber says. "Although positive emotions are generally good for us, when they take extreme forms or when they're experienced in the wrong context, the benefits of positive emotion begin to unravel," she says. The goal: "experience it in moderation, in the right place and time."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Association for Psychological Science.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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New way to examine major depressive disorder in children

ScienceDaily (May 10, 2011) — A landmark study by scientists at Wayne State University published in the May 6, 2011, issue of Archives of General Psychiatry, has revealed a new way to distinguish children with major depressive disorder (MDD) from not only normal children, but also from children with obsessive compulsive disorder (OCD).

MDD is a common, debilitating disease prevalent in childhood and adolescence. Examination of cortical thickness in patients with MDD has not been widely studied, and WSU's team of researchers set out to determine if differences in cortical thickness might not only distinguish children with depression from healthy children who are not depressed but also from those with other psychiatric disorders such as OCD.

Using a new technique to measure cortical thickness of 24 MDD patients, 24 OCD patients and 30 healthy control patients, the research team led by David Rosenberg, M.D., the Miriam L. Hamburger Endowed Chair of Child Psychiatry and professor of psychiatry and behavioral neurosciences in the School of Medicine at Wayne State University, and Erin Fallucca, M.D., a psychiatry resident at Wayne State University and the Detroit Medical Center, observed cortical thinning in five regions of the brain and greater thickness in the bilateral temporal pole in MDD patients. In OCD patients, the only significantly different region from healthy control patients was a thinner left supramarginal gyrus.

"The findings from our study are very exciting," said Rosenberg. "By measuring cortical thickness, we were able to distinguish depressed children not only from healthy children without depression, but also from those with another psychiatric disorder, obsessive compulsive disorder."

The study also revealed that familial depressed patients, or children with at least one first-degree relative with depression, had distinct cortical thickness compared to children with no obvious family history of mood disorder.

"Depressed children with and without a family history of depression who met the same clinical criteria of depression and who appeared the same clinically, had completely different cortical thickness based on their family history of depression," said Rosenberg.

This study offers an exciting new way to identify more objective markers of psychiatric illness in children. "It may have potential treatment significance for one-third of depressed children who do not respond to any treatment, and also for many who only partially respond with continued functional impairment," said Rosenberg. "We have found a clue to guide us to look at subtypes of depression just as we would in other chronic medical illnesses like diabetes, such as insulin dependent and non-insulin dependent diabetes."

This study was supported in part by the Paul Strauss Endowment for the Integration of Computer Science and Psychiatry, the National Institute of Mental Health of the National Institutes of Health, the State of Michigan Joe F. Young Sr. Psychiatric Research and Training Program, the World Heritage Foundation, the Schutt Foundation, the United Way, the National Alliance for Research on Schizophrenia and Depression and the Mental Illness Research Association.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Wayne State University.

Journal Reference:

E. Fallucca, F. P. MacMaster, J. Haddad, P. Easter, R. Dick, G. May, J. A. Stanley, C. Rix, D. R. Rosenberg. Distinguishing Between Major Depressive Disorder and Obsessive-Compulsive Disorder in Children by Measuring Regional Cortical Thickness. Archives of General Psychiatry, 2011; 68 (5): 527 DOI: 10.1001/archgenpsychiatry.2011.36

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Limitations of evidence base for prescribing aripiprazole in maintenance therapy of bipolar disorder

ScienceDaily (May 3, 2011) — The evidence base for the prescribing of aripiprazole in maintenance treatment of bipolar disorder is limited to a single trial, sponsored by the manufacturer of aripiprazole, according to a rigorous appraisal of the evidence for its use led jointly by Alexander Tsai of Harvard University, Boston USA, and Nicholas Rosenlicht of the University of California San Francisco, USA. In the paper, published in PLoS Medicine, the authors describe key limitations of the trial, which were not identified in most subsequent review articles and guidelines for the treatment of bipolar disorder in which the trial was cited.

Bipolar disorder (also known as manic depression) is a common and serious psychiatric illness. Individuals with bipolar disorder experience mood swings with manic episodes (where they may feel euphoric, restless, and behave impulsively), along with depressive episodes where they may feel low, worthless, and suicidal. Aripiprazole is a second-generation antipsychotic medication and the newest of such drugs to have received approval by the US Food and Drug Administration (FDA) for use both in treatment of acute episodes and, more recently, for maintenance therapy.

Drs. Tsai and Rosenlicht and their colleagues conducted a systematic search to find all published and unpublished studies relating to use of aripiprazole for maintenance therapy of bipolar disorder, including a request to the FDA under Freedom of Information Act legislation. They critically appraised this evidence and then used citation searches to examine how the primary evidence was subsequently referenced in the medical literature. The authors found only a single trial describing the use of aripiprazole during the maintenance phase of bipolar disorder. Further, they found significant limitations of this trial that constrain its interpretation as supporting the use of aripiprazole for this indication. First, the trial duration was too short to show that the drug was truly helpful in maintaining initial benefit or preventing mood swings over the long term. Second, very few participants in the trial completed the entire study. Third, the trial was based on a select minority of subjects who had shown an initial response to the drug, making it difficult to extrapolate these findings to patients with bipolar disorder more widely. Fourth, the trial had a design whereby patients assigned to placebo were abruptly taken off aripiprazole treatment given to them during a previous "run-in" phase and reassigned to placebo; differences in risk of relapse seen between trial arms may thus also reflect the potentially harmful effects of rapid drug withdrawal in patients given placebo.

Despite these shortcomings, the authors found that this single trial was subsequently cited by 104 review articles and treatment guidelines, with very few mentioning the study's limitations.

The authors comment that "…alternative modifications or study designs may improve the probability of generating more useful data from studies in this vulnerable patient population to inform the treatment of similar patients in the future."

Patients (or their family members) who may learn of this study's findings are urged to contact their physician if concerned about what these findings may mean for their treatment. Specifically, the findings do not mean patients should cease their medication; despite the limitations of the evidence described here, this drug may be helpful to them. In addition, the study did not assess the evidence for the use of aripiprazole in acute treatment of bipolar disorder.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Public Library of Science, via EurekAlert!, a service of AAAS.

Journal Reference:

Alexander C. Tsai, Nicholas Z. Rosenlicht, Jon N. Jureidini, Peter I. Parry, Glen I. Spielmans, David Healy. Aripiprazole in the Maintenance Treatment of Bipolar Disorder: A Critical Review of the Evidence and Its Dissemination into the Scientific Literature. PLoS Medicine, 2011; 8 (5): e1000434 DOI: 10.1371/journal.pmed.1000434

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Eight-question survey can help predict post-traumatic stress disorder

ScienceDaily (July 18, 2011) — A simple eight-question survey administered soon after injury can help predict which of the 30 million Americans seeking hospital treatment for injuries each year may develop depression or post-traumatic stress, report Therese S. Richmond, PhD, CRNP, associate professor at the University of Pennsylvania School of Nursing, and her colleagues in General Hospital Psychiatry.

"Depression and PTSD exert a significant, independent, and persistent effect on general health, work status, somatic symptoms, adjustment to illness, and function after injury," the authors wrote, also emphasizing that even minor injuries can lead to traumatic stress responses. The findings allow healthcare providers to identify patients at highest risk for developing these disorders and to target appropriate resources to this vulnerable group.

This screening tool -- reportedly one of the first of its kind for adults in the U.S. -- could have a great impact on the judicious allocation of costly mental health resources.

Using an eight-question survey, all injured patients can be rapidly assessed for risk in the hospital. Healthcare providers can then provide patients classed as high-risk for developing depression or PTSD with information about symptoms to look for and advise them to contact their primary care provider should symptoms surface. This intervention can facilitate early diagnosis of these disabling disorders.

The study reported nearly 100 percent accuracy in negative results. Only five percent of injured patients who tested negative for risk of depression on the screening survey developed depression and no patients who tested negative for PTSD risk developed PTSD. At the same time, not all patients who screen positive will develop these disorders. The researchers do not suggest that all patients who screen positive receive mental health services, but rather that this finding prompt systematic provision of information and additional follow-up.

The authors caution that while the findings of this initial study are most promising, they need to be replicated in an independent sample.

With Dr. Richmond, the study authors are: Josef Ruzek, PhD; Theimann Ackerson, MSSW; Douglas J. Wiebe, PhD; Flaura Winston, MD, PhD; Nancy Kassam-Adams, PhD.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Pennsylvania School of Nursing, via EurekAlert!, a service of AAAS.

Journal Reference:

Therese S. Richmond, Josef Ruzek, Theimann Ackerson, Douglas J. Wiebe, Flaura Winston, Nancy Kassam-Adams. Predicting the future development of depression or PTSD after injury. General Hospital Psychiatry, 2011; DOI: 10.1016/j.genhosppsych.2011.05.003

Note: If no author is given, the source is cited instead.

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Post-traumatic stress disorder common following significant orthopedic trauma

ScienceDaily (July 7, 2011) — Although most commonly associated with military combat, post-traumatic stress disorder (PTSD) can occur in civilians, too -- and with consequences that are just as serious, according to a new review article in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). PTSD is a type of anxiety disorder that occurs after a person experiences a traumatic event involving physical injury, and occurs in 20 to 51 percent of patients with an orthopaedic injury.

"PTSD occurs with a significant frequency in civilian patients who have sustained an orthopaedic trauma, and it can hinder their emotional, physical and functional recovery following orthopaedic treatment," said Daniel Aaron, MD, a clinical instructor in the department of orthopaedics at Brown University in Providence, R.I.

Many types of accidents can cause PTSD, including car or motorcycle accidents, gunshot wounds, vehicle-pedestrian accidents and falls from height, among many others.

"Generally, higher-energy mechanisms are most commonly associated with PTSD, but no specific type of fracture or injury has been identified," Dr. Aaron said. "Basically, any type of muscuolskeletal injury that results from significant trauma may be associated with PTSD."

PTSD can have a significant impact on a patient's ability to perform simple, daily chores, and can slow the rehabilitation process, even affecting how the patient experiences pain and perceives his or her recovery.

"The development of PTSD adversely affects the ability of the patient to recover and may specifically compromise physical rehabilitation and patient satisfaction following orthopaedic treatment," Dr. Aaron said. "Without effective treatment, PTSD can hinder activities of daily living, such as bathing, eating, paying bills, shopping, laundry and other household chores. Patients with PTSD also may be delayed in returning to work."

A diagnosis of PTSD relies on the presence of specific behaviors or symptoms, including:

re-experiencing the traumatic event, including nightmares, flashbacks and intrusive memories;avoiding situations reminiscent of the original trauma, reluctance to talk or think about the original trauma, or feeling emotionally "numb" about the event; and,anger, irritability, difficulty concentrating, insomnia and/or an increased startle response.

In addition, the symptoms must have occurred for at least one month and they must be severe enough to cause a noticeable change in normal behavior.

PTSD can occur in any person at any age, but Dr. Aaron said several risk factors make PTSD more likely to occur, including:

One study also suggests people of Hispanic origin may be at greater risk for PTSD, he added.

"Although no single prevention protocol has been described, therapy with a psychiatrist or psychologist may help, as well as the use of certain medications, including anti-depressants and anti-anxiety medications," Dr. Aaron said.

Recognizing the symptoms of PTSD early offers the best chance of effective prevention. Orthopaedic surgeons can improve patient outcomes by knowing which patients are at risk of developing PTSD and initiating prevention strategies, noted Dr. Aaron. Some studies indicate that when PTSD is identified early, progression of the condition may be prevented through use of medications, he added.

"Identifying at-risk patients is an important first step in preventing the ill effects of PTSD," he said. Many orthopaedic surgeons may not recognize the signs and symptoms of PTSD, and remain unaware of prevention and treatment strategies. As a result, recovery can be delayed.

In addition to understanding and evaluating for the risk factors of PTSD, asking patients questions about the emotional and physical problems they are experiencing as a result of their injury can also help physicians determine if a patient is at risk for developing the condition.

Treatment of PTSD begins with referral to a psychiatric professional, who may prescribe medication and implement a behavioral therapy program to help deal with the traumatic event and its effects.

Although PTSD clearly impacts recovery in patients with orthopaedic injury, currently there are no studies that directly link treatment or resolution of PTSD with orthopaedic improvement, and many of the options for treatment of PTSD are in the experimental stage, Dr. Aaron noted.

"In addition to continuing to look at treatment options and their effects, we need to study the effectiveness of prevention strategies," he said. "And we also need to look at whether physical and functional outcomes do indeed improve as the emotional symptoms of PTSD are treated."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Academy of Orthopaedic Surgeons.

Journal Reference:

Daniel L. Aaron, Paul D. Fadale, Colin J. Harrington, and Christopher T. Born. Posttraumatic Stress Disorders in Civilian Orthopaedics. J Am Acad Orthop Surg, Vol 19, No 5, May 2011, 245-250 [link]

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here