1,721,053 research outputs found
Suicide in bipolar disorder: risks and management
No full textBipolar disorders are prevalent, often severe, and disabling illnesses with elevated lethality largely due to suicide. Suicide rates average ∼1% annually, or perhaps 60 times higher than the international population rate of 0.015% annually. Suicidal acts typically occur early in bipolar disorders and in association with severe depressive or mixed states. The high lethality of suicidal acts in bipolar disorders is suggested by a much lower ratio of attempts:suicide (∼3:1) than in the general population (∼30:1). Risk factors can help to identify patients at increased suicidal risk, but ongoing clinical assessment is essential to limit risk. Empirical short-term interventions to manage acute suicidal risk include close clinical supervision, rapid hospitalization, and electroconvulsive therapy. Remarkably, however, evidence of the long-term effectiveness of most treatments against suicidal behavior is rare. A notable exception is lithium prophylaxis, which is associated with consistent evidence of major (∼80%), sustained relative reductions of risk of suicides and attempts, and lower lethality (increased attempts:suicide ratio). Such benefits are unproved for other treatments commonly used to treat bipolar disorder patients, including anticonvulsants, antipsychotics, antidepressants, and psychosocial interventions. Applying available knowledge systematically, with close and sustained clinical supervision, can enhance management of suicidal risk in bipolar disorders patients
Effects of Treatment of Acute Major Depressive Episodes in Bipolar I Versus Bipolar II Disorders With Quetiapine
No full textBackground Several second-generation antipsychotic drugs (SGAs) have evidence of benefit for acute major depressive episodes in bipolar disorder (BD) patients. However, their comparative efficacy in types I vs II BD (BD1 vs BD2) remains uncertain. Methods We carried out a systematic literature search for randomized, double-blinded, controlled treatment trials for acute major depressive episodes involving head-to-head comparisons of BD1 versus BD2 subjects, followed by meta-analyses and meta-regression modeling. Results Seven reports met out inclusion criteria, yielding 22 comparisons of SGA versus placebo averaging 8.3 weeks in duration. All trials involved quetiapine, which was much more effective than placebo (pooled standardized mean difference [SMD] = 1.76 [95% confidence interval, 1.40-2.12], P BD2) to be the only factor significantly associated with the meta-analytic outcome. Conclusions Although data are limited, depressed BD1 patients may respond somewhat better to quetiapine than BD2. Additional head-to-head diagnostic comparisons are needed with other SGAs, as well as evaluation of monotherapy versus various combinations that include SGAs in both short- and long-term use
Relationships of affective temperament ratings to diagnosis and morbidity measures in major affective disorders
Full text linkBackground Ratings of affective temperament types show promise in helping to differentiate diagnostic groups among major affective disorders as well as to predict associations with important aspects of morbidity including suicidal risk. Methods The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-rating (TEMPS-A) questionnaire was completed by 858 unselected, consecutive, consenting adults diagnosed with a DSM-5 major affective disorder (173 bipolar-1 [BD-1]), 250 BD-2, 435 major depressive disorder [MDD]) to score for anxious (anx), cyclothymic (cyc), dysthymic (dys), hyperthymic (hyp), and irritable (irr) affective temperaments. We tested their associations with diagnosis and selected clinical factors, including diagnosis, depression scores, suicidal ideation or acts, substance abuse, episodes/year, and %-Time ill. Results Scores for cyc ranked: BD-2Â >Â BD-1Â >Â MDD; anx ranked: MDDÂ >Â BD-2Â >Â BD-1; irr was greater in BD than MDD; dys was greater in MDD than BD; ..
Bipolar disorders following initial depression: modeling predictive clinical factors
No full textOBJECTIVE: Most first lifetime episodes among persons eventually diagnosed with
bipolar disorder are depressive, often with years of delay to a final
differentiation from unipolar major depression. To support early differentiation,
we tested several predictive factors for association with later diagnoses of
bipolar disorder.
METHOD: With data from mood-disorder patients with first-lifetime episodes of
major depression, we used multivariate, logistic modeling and Bayesian methods
including Receiver Operating Characteristic curves to evaluate ability of one or
more selected factors to differentiate patients who later met DSM-IV-TR
diagnostic criteria for bipolar disorder and not unipolar major depressive
disorder.
RESULTS: We analyzed data from 2146 patients (642 bipolar, 1504 unipolar) at risk
for 13 years following initial depressive episodes. In multivariate modeling for
812 subjects with information on all clinical factors considered, seven
significantly and independently differentiated bipolar from unipolar disorders,
ranking (by significance): (a) ≥4 previous depressive episodes, (b) suicidal
acts, (c) cyclothymic temperament, (d) family history of bipolar disorder, (e)
substance-abuse, (f) younger-at-onset, or onset-age <25, and (g) male sex; four
of these (c, d, f, g) can be identified at illness-onset. Bayesian analysis
indicated optimal sensitivity and specificity at 2-4 factors/person and correct
classification of 64-67% of cases, and ROC analysis of factors/person yielded a
significant area-under-the-curve of 0.72 [CI: 0.68-0.75].
CONCLUSIONS: In multivariate modeling, 7 factors were significantly and
independently associated with bipolar disorder diagnosed up to 13 years after
initial depression
Comparison of bipolar disorder type II and major depressive disorder
No full textObjective: Compare patients diagnosed as DSM-5 type II bipolar disorder (BD2) vs. major depressive disorder (MDD). Methods: We compared characteristics of 3246 closely and repeatedly evaluated, consenting, adult patient-subjects (n = 706 BD2, 2540 MDD) at a specialty clinic using bivariate methods and multivariable modeling. Results: Factors more associated with BD2 than MDD included: [a] descriptors (more familial psychiatric, mood and bipolar disorders and suicide; younger at onset, diagnosis and first-treatment; more education; more unemployment; fewer marriages and children; higher cyclothymic, hyperthymic and irritable temperament ratings, lower anxious); [b] morbidity (more hypomanic, mixed or panic first episodes; more co-occurring general medical diagnoses, more Cluster B personality disorder diagnoses and ADHD; more alcohol and drug abuse and smoking; shorter depressive episodes and interepisode periods; lower intake ratings of depression and anxiety, higher for hypomania; far more mood-switching with antidepressants; lower %-time depressed; DMI > MDI course-pattern in BD2; more suicide attempts and violent suicidal behavior); [c] item-scores with intake HDRS21 higher for suicidality, paranoia, anhedonia, guilt, and circadian variation; lower somatic anxiety, depressed mood, insight, hypochondriasis, agitation, and insomnia; and [d] treatment (more lithium, mood-stabilizing anticonvulsants and antipsychotics, less antidepressants and benzodiazepines). Conclusions: BD2 and MDD subjects differed greatly in many descriptive, psychopathological and treatment measures, notably including more familial risk, earlier onset, more frequent recurrences and greater suicidal risk with BD2. Such differences can contribute to improving differentiation of the disorders and planning for their treatment
On the periodicity of manic-depressive insanity, by Eliot Slater (1938):translated excerpts and commentary.
No full text
- …
