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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bipolar mixed states combine depressive and manic features, presenting diagnostic and treatment challenges and reflecting a severe form of the illness. DSM-IV criteria for a mixed state require combined depressive and manic syndromes, but a range of mixed states has been described clinically. A unified definition of mixed states would be valuable in understanding their diagnosis, mechanism and treatment implications. We investigated the manner in which depressive and manic features combine to produce a continuum of mixed states. In 88 subjects with bipolar disorder (DSM-IV), we evaluated symptoms and clinical characteristics, and compared depression-based, mania-based, and other published definitions of mixed states. We developed an index of the extent to which symptoms were mixed (Mixed State Index, MSI) and characterized its relationship to clinical state. Predominately manic and depressive mixed states using criteria from recent literature, as well as Kraepelinian mixed states, had similar symptoms and MSI scores. Anxiety correlated significantly with depression scores in manic subjects and with mania scores in depressed subjects. Discriminant function analysis associated mixed states with symptoms of hyperactivity and negative cognitions, but not subjective depressive or elevated mood. High MSI scores were associated with severe course of illness. For depressive or manic episodes, characteristics of mixed states emerged with two symptoms of the opposite polarity. This was a cross-sectional study. Mixed states appear to be a continuum. An index of the degree to which depressive and manic symptoms combine appears useful in identifying and characterizing mixed states. We propose a depressive or manic episode with three or more symptoms of the opposite polarity as a parsimonious definition of a mixed state.
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PMID:Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features. 1981 54

Olanzapine was licensed in the USA by the Food and Drug Administration in 2003 for the prevention of relapse in patients with bipolar disorder when the acute manic episode had responded to treatment with olanzapine. However, olanzapine is commonly used in clinical practice for preventing relapse in patients with bipolar disorder even when acute response has not been demonstrated. The aim of this systematic review and meta-analysis is to determine the effectiveness and acceptability of olanzapine in preventing recurrent mood episodes in bipolar disorder. MEDLINE, EMBASE, the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled up to July 2008 were accessed. Only randomised controlled trials comparing olanzapine with placebo or other active drugs for long-term treatment were included. Two reviewers independently extracted data. Authors were contacted to provide additional data. Of the five trials included in this review, four were conducted by Eli Lilly, the manufacturer of olanzapine. Olanzapine was more effective than placebo at preventing manic relapse, but there was no difference between olanzapine (alone or in combination with lithium or valproate) and placebo (alone or in combination with lithium or valproate) in terms of relapse into any mood episode, as defined as primary outcome by authors in each of the primary studies. We conclude that olanzapine may prevent further manic episodes only in patients who have responded to olanzapine in an acute manic or mixed episode and who have not previously had a satisfactory response to lithium or valproate.
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PMID:Olanzapine in the long-term treatment of bipolar disorder: a systematic review and meta-analysis. 1982 71

Previous neuroimmunological studies focused mostly on depression, regardless of its diagnostic category. In this paper, the studies on the immunological system in patients with bipolar affective illness, including manic episode, have been presented. Research possibilities of neuroimmunology of affective disorders using molecular-genetic methods have also been shown. The studies on the neuroimmunology of depression have always been connected with studies on changes in the immunological system related to stress situations. Disturbances of the immunological system regulation have features of either decrease or pathological increase of the immunological system, with increased activity of pro-inflammatory cytokines (interleukin 1 and 6, interferon). Some pathogenic role for the disturbances of immunological system in depression is also played by viral infections (herpes, Borna viruses). The changes of the immunological system in mania are mostly similar to those observed during depression. An increase of activity of pro-inflammatory cytokines, connected with the lymphocyte Th1 system is especially evident. Like in depression, the role of viral infections has been pointed out (herpes, Borna, parvovirus B19). The oldest mood-stabilizing drug, lithium, has been shown to have strong action against herpes viruses. Molecular-genetic studies point to an association of some genes of the immunological system with both bipolar disorder and schizophrenia. An association of some genes with a predisposition to depression and efficacy of antidepressant drugs has also been shown.
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PMID:[Neuroimmunology of bipolar affective disorder]. 2044 78

A manic episode in old age presents a diagnostic challenge to the clinician due to the different symptomatology often difficult to distinguish from delirium, dementia, agitated depression and psychosis. To complicate matters further, a first episode of mania in later life is very often based on underlying physical and cerebral pathology ('secondary mania'). Many causes of 'secondary mania', including neurological, systemic or endocrine diseases, infections, intoxications, apnoea, post-thoracic surgery and vitamin B12 deficiency have been described to date, but there have been no reports on subdural haematomas in this context. However, the elderly are more prone to subdural haematomas following head trauma than younger patients. We present two case reports of older patients with a first manic episode in later life probably caused by subdural haematomas. A first episode of mania in later life always requires thorough assessment of the patient to determine physical and cerebral pathology.
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PMID:[First manic episode in the elderly--consider a subdural haematoma due to head trauma as cause]. 2045 95

Bipolar disorder is relatively common, at least twice as common as schizophrenia, and eminently treatable. It is also perfectly suited to the well established outpatient model practised in general practice and psychiatry. All GP practices should include people with a diagnosis of bipolar disorder on their case register of people with severe mental illness. It is not possible to exclude a bipolar diagnosis categorically if there are only symptoms of depression. Most patients will have had a (hypo)manic episode by their 30s. The lifetime prevalence of bipolar affective disorder proper is 1%, with a further 1.2% presenting with milder hypomanic symptoms (so-called bipolar II disorder). Relaxing diagnostic symptom criteria increases the frequency of depressed patients who develop symptoms of mania for any length of time to 50%. The lifetime course of the illness tends to be dominated by depressive episodes: half the time is estimated to be spent in the euthymic (well) state, 12% in a manic state and 38% in a depressed state. Any depressed patient should be asked about periods in the past when (s)he has been elated in mood, found it unnecessary to sleep, talked a lot, spent excessive amounts of money etc. Treatment for bipolar disorder has to be divided into: treatment of mania, treatment of bipolar depression and prophylaxis of mood swings in either direction. Antidepressant treatments are unlikely to help manic symptoms, at worst they can precipitate or aggravate them. Antimanic treatments are unlikely to help symptoms of depression but an exception to this rule would be a genuine mood stabiliser, such as lithium. Patients with bipolar disorder should have an annual physical health review. This will include monitoring for weight gain, lipid levels, plasma glucose levels, smoking status and alcohol use, as well as blood pressure.
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PMID:Managing bipolar disorder in primary care. 2056 77

In this study, we aimed to extend the present knowledge regarding the relationship of personality traits, as specified by the five-factor model (FFM), with the affective morbidity of bipolar I disorder. The primary aim of this study is to investigate the association of personality traits with affective morbidity, particularly with hospitalization for depressive, manic, or mixed episodes, in patients with bipolar I disorder. The Revised NEO Personality Inventory was administered to 83 subjects who showed a euthymic mood state. Multivariate Poisson regression analysis was performed to identify associations between five domains of personality and the number of hospitalizations for affective episode(s) (manic, depressive, and mixed state). As a secondary research interest, we attempted to determine personality traits which would be significantly different between subjects with Affective Switch from mania into depression Without Euthymia (ASWE) and non-ASWE. The Neuroticism score was positively associated with the number of hospitalization for depression and the total number of hospitalizations Extraversion and Openness scores showed a negative relationship with the number of hospitalizations for depression and the total number of hospitalizations. We found that ASWE patients showed significantly higher Neuroticism scores than did the non-ASWE group. However, there was no significant association between the hospitalization for manic episode and any particular personality trait based on the FFM. This study reveals that personality traits based on the FFM may contribute to an increased likelihood of depressive morbidity and switch into depression.
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PMID:Personality traits and affective morbidity in patients with bipolar I disorder: the five-factor model perspective. 2056 18

Tuberous sclerosis is a rare disorder. Mental retardation, epilepsy, autism and hyperactivity are commonly reported neuropsychiatric disorders associated with tuberous sclerosis. Rarely, other psychiatric disorders such as psychosis, depression and anxiety associated with this condition have been reported in the literature. A case of bipolar disorder associated with tuberous sclerosis with onset of the first manic episode at the age of 7 years is reported. The possibility of tuberous sclerosis as one of the causes of secondary mood disorder in very young children is also discussed.
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PMID:Bipolar disorder associated with tuberous sclerosis: Chance association or aetiological relationship? 2070 20

Bipolar disorder is a frequent disorder in the elderly, with a prevalence of 0.1 a 0.4%; a 10% of bipolar patients have mania onset after 50 years old. It has in ageing a more heterogeneous clinical presentation. The manic episodes are less severe, mixed depression is common, as well as confusion and cognitive impairment. A first manic episode in ageing can be secondary to medical illness. Treatment for bipolar disorder in ageing is similar to treatment for young patients. The differences are due to pharmacocinetic changes because of the age, with the comorbidity and with the etiology, if it is a secondary mania. Lithium can be the first choice for treating mania in patients with antecedent of good response and have tolerance to adverse effects, but because of its toxicity and secondary effects other possibilities may be considered: divalproate, cabamazepine, antipsychotics. There are some little studies that show lamotrigine efficacy in bipolar depression in elderly. We need more specific studies about bipolar disorder treatment in aging.
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PMID:[Bipolar disorder in the elderly]. 2118 15

In the evaluation of patients presenting with altered mental function searching for underlying medical conditions is necessary. Abnormal thyroid function has long been implicated in mood changes with the classic associations of depression occurring together with hypothyroidism and of mania along with hyperthyroidism. We here report 3 patients who presented with symptoms consistent with acute manic episode diagnosed using DSM IV-TR criteria and who were found to have primary hypothyroidism biochemically. This led to a review of the literature on this phenomenon resulting in the identification of 10 reports of mania and associated thyroid profiles consistent with primary hypothyroidism. All 3 of our patients improved clinically after use of levothyroxine and psychotropic medications, consistent with the literature reports. This illustrates that thyroid function abnormalities including primary hypothyroidism should be considered and screened for when evaluating patients with acute manic episodes.
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PMID:Primary hypothyroidism associated with acute mania: case series and literature review. 2155 58

51 patients who were admitted for their first manic episode were followed up for 4 years after discharge from the hospital. 32 (62.7%) patients came for regular follow-ups whereas 19 (37.3%) patients did not come for any follow up. 19 (59.4%) patients out of the 32 patients had subsequent recurrences. 8 (25.0%) patients had a single recurrence only, whereas 11 (34.4%) patients had multiple recurrences. In total, 31 (74.19%) recurrences occurred in 4 years, out of which 23 (25.81%) recurrences were for mania and only 8 for depression. 46.88% patients had relapsed at the end of the first year and by the third year all 19 (59.4%) patients had relapsed. The chances of having a depressive episode was highest in the first six months after recovery from manic episode. Patients with a family history of bipolar illness had a more deleterious course. Poor drug compliance was a factor associated with greater relapse rates. Amongst the patients receiving regular medication, the patients who were on lithium had the best outcome. 48.8% patients had subsequent admissions in the four year follow up. Patients with late age of onset and substance abuse had required greater number of admissions.
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PMID:Four year follow-up of first episode manic patients. 2158 64


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