Browsing by Subject "Bipolar Disorder"
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Item Open Access Bipolar Depression: Pregnancy, Postpartum, and Lactation.(The Psychiatric clinics of North America, 2016-03) Wald, Marla F; Muzyk, Andrew J; Clark, DrueMedication management of bipolar depression in pregnancy and lactation is best done by assessing each patient's and family's needs in detail. Keeping pregnant patients as psychiatrically stable as possible is the most important principle for clinicians. Unfortunately, there is no risk-free situation for patients with psychiatric illness. This is often the most difficult and hard to accept reality for these patients, families, and clinicians. Clinicians serve these patients best by being as transparent as possible about the risk/benefit analysis of each patient's situation with the realization that ultimately the decisions are made by the patient and family.Item Open Access Psychotherapeutic Treatment of Bipolar Depression.(The Psychiatric clinics of North America, 2016-03) McMahon, Kibby; Herr, Nathaniel R; Zerubavel, Noga; Hoertel, Nicolas; Neacsiu, Andrada DThe gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach.Item Open Access Targeting Treatments to Improve Cognitive Function in Mood Disorder: Suggestions From Trials Using Erythropoietin.(The Journal of clinical psychiatry, 2016-12) Miskowiak, Kamilla Woznica; Rush, A John; Gerds, Thomas A; Vinberg, Maj; Kessing, Lars VObjective
There is no established efficacious treatment for cognitive dysfunction in unipolar and bipolar disorder. This may be partially due to lack of consensus regarding the need to screen for cognitive impairment in cognition trials or which screening criteria to use. We have demonstrated in 2 randomized placebo-controlled trials that 8 weeks of erythropoietin (EPO) treatment has beneficial effects on verbal memory across unipolar and bipolar disorder, with 58% of EPO-treated patients displaying a clinically relevant memory improvement as compared to 15% of those treated with placebo.Methods
We reassessed the data from our 2 EPO trials conducted between September 2009 and October 2012 to determine whether objective performance-based memory impairment or subjective self-rated cognitive impairment at baseline was related to the effect of EPO on cognitive function as assessed by Rey Auditory Verbal Learning Test (RAVLT) total recall with multiple logistic regression adjusted for diagnosis, age, gender, symptom severity, and education levels.Results
We included 79 patients with an ICD-10 diagnosis of unipolar or bipolar disorder, of whom 39 received EPO and 40 received placebo (saline). For EPO-treated patients with objective memory dysfunction at baseline (n = 16) (defined as RAVLT total recall ≤ 43), the odds of a clinically relevant memory improvement were increased by a factor of 290.6 (95% CI, 2.7-31,316.4; P = .02) compared to patients with no baseline impairment (n = 23). Subjective cognitive complaints (measured with the Cognitive and Physical Functioning Questionnaire) and longer illness duration were associated with small increases in patients' chances of treatment efficacy on memory (53% and 16% increase, respectively; P ≤ .04). Diagnosis, gender, age, baseline depression severity, and number of mood episodes did not significantly change the chances of EPO treatment success (P ≥ .06). In the placebo-treated group, the odds of memory improvement were not significantly different for patients with or without objectively defined memory dysfunction (P ≥ .59) or subjective complaints at baseline (P ≥ .06).Conclusions
Baseline objectively assessed memory impairments and-to a lesser degree-subjective cognitive complaints increased the chances of treatment efficacy on cognition in unipolar and bipolar disorder.Trial registration
ClinicalTrials.gov identifier: NCT00916552.Item Open Access The genetic association between personality and major depression or bipolar disorder. A polygenic score analysis using genome-wide association data.(Translational psychiatry, 2011-10-18) Middeldorp, CM; de Moor, MHM; McGrath, LM; Gordon, SD; Blackwood, DH; Costa, PT; Terracciano, A; Krueger, RF; de Geus, EJC; Nyholt, DR; Tanaka, T; Esko, T; Madden, PAF; Derringer, J; Amin, N; Willemsen, G; Hottenga, J-J; Distel, MA; Uda, M; Sanna, S; Spinhoven, P; Hartman, CA; Ripke, S; Sullivan, PF; Realo, A; Allik, J; Heath, AC; Pergadia, ML; Agrawal, A; Lin, P; Grucza, RA; Widen, E; Cousminer, DL; Eriksson, JG; Palotie, A; Barnett, JH; Lee, PH; Luciano, M; Tenesa, A; Davies, G; Lopez, LM; Hansell, NK; Medland, SE; Ferrucci, L; Schlessinger, D; Montgomery, GW; Wright, MJ; Aulchenko, YS; Janssens, ACJW; Oostra, BA; Metspalu, A; Abecasis, GR; Deary, IJ; Räikkönen, K; Bierut, LJ; Martin, NG; Wray, NR; van Duijn, CM; Smoller, JW; Penninx, BWJH; Boomsma, DIThe relationship between major depressive disorder (MDD) and bipolar disorder (BD) remains controversial. Previous research has reported differences and similarities in risk factors for MDD and BD, such as predisposing personality traits. For example, high neuroticism is related to both disorders, whereas openness to experience is specific for BD. This study examined the genetic association between personality and MDD and BD by applying polygenic scores for neuroticism, extraversion, openness to experience, agreeableness and conscientiousness to both disorders. Polygenic scores reflect the weighted sum of multiple single-nucleotide polymorphism alleles associated with the trait for an individual and were based on a meta-analysis of genome-wide association studies for personality traits including 13,835 subjects. Polygenic scores were tested for MDD in the combined Genetic Association Information Network (GAIN-MDD) and MDD2000+ samples (N=8921) and for BD in the combined Systematic Treatment Enhancement Program for Bipolar Disorder and Wellcome Trust Case-Control Consortium samples (N=6329) using logistic regression analyses. At the phenotypic level, personality dimensions were associated with MDD and BD. Polygenic neuroticism scores were significantly positively associated with MDD, whereas polygenic extraversion scores were significantly positively associated with BD. The explained variance of MDD and BD, ∼0.1%, was highly comparable to the variance explained by the polygenic personality scores in the corresponding personality traits themselves (between 0.1 and 0.4%). This indicates that the proportions of variance explained in mood disorders are at the upper limit of what could have been expected. This study suggests shared genetic risk factors for neuroticism and MDD on the one hand and for extraversion and BD on the other.